Utilization Review Nurse, PRN

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🔥 0 minutes ago

🇺🇸 United States – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

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Netsmart

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1973

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Netsmart is a leading provider of comprehensive EHR solutions tailored for a wide range of care settings, especially in behavioral health, addiction treatment, autism, geriatrics, and intellectual and developmental disabilities. The company offers a range of software products that streamline operations, enhance care coordination, and promote value-based care across healthcare communities. In addition to EHRs, Netsmart provides technology solutions for care coordination, telehealth, population health management, and revenue cycle management, aiming to support the delivery of integrated and person-centered care. Their solutions are used in a variety of sectors including human services, post-acute care, and public health, making Netsmart a significant player in the healthcare technology industry.

📋 Description

• Review and evaluate electronic medical records of emergency department admissions • Screen admissions for medical necessity using InterQual or MCG criteria • Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources • Participate in telephonic discussions with emergency department physicians regarding documentation and admission status • Enter clinical review information into the system for transmission to insurance companies for authorization • Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources

🎯 Requirements

• Current and unrestricted RN license • At least 3 years (36 months) clinical experience in an acute care setting in emergency room, critical care and/or medical/surgical nursing • At least 2 years utilization management experience in acute admission and concurrent reviews • Intermediate-level experience with InterQual and/or MCG criteria within the last two years • Proficiency in medical record review in an electronic medical record (EMR) • Experience with Microsoft Suite, including Office and basic Excel • Ability to thrive in a fast-paced, dynamic environment and adapt to frequently changing business needs • Passing score(s) on job-related pre-employment assessment(s) • All applicants must be legally authorized to work in the United States • Netsmart does not provide work visa sponsorship for this position • Comfortable with remote work arrangements and virtual collaboration tools • Physical demands include extended periods of sitting, computer use, and telephone communication • Preferred: at least 5 years clinical experience in an acute care setting • Preferred: at least 3 years utilization management experience within the hospital setting • Preferred: Bachelor of Science in Nursing (BSN) • Preferred: case management certifications such as CCM, ACM, CMCN, or CMGT-BC

🏖️ Benefits

• Remote work arrangements • Virtual collaboration tools • Pre-employment background check and drug screen provided at Netsmart’s sole expense • Equal employment and advancement opportunities • Inclusive workplace environment