Utilization Review Nurse

🔥 12 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 for emergency department admissions • Screen admissions for medical necessity using InterQual or MCG criteria • Apply evidence-based clinical guidelines to assess appropriate 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, trends, problems, or inappropriate resource utilization • Work assigned shifts between 9am EST and 9pm EST • Adjust availability or work different shifts based on client needs and operational demands

🎯 Requirements

• Current and unrestricted RN license • At least 3 years of clinical experience in an acute care setting in emergency room, critical care and/or medical/surgical nursing • At least 2 years of 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 • No work visa sponsorship is provided • Preferred: at least 5 years of clinical experience in an acute care setting • Preferred: at least 3 years of utilization management experience within the hospital setting • Preferred: Bachelor’s of Science in Nursing (BSN) • Preferred: case management certifications such as CCM, ACM, CMCN, or CMGT-BC

🏖️ Benefits

• Comfortable with remote work arrangements and virtual collaboration tools • Full-time schedule includes 4 holidays per year • Full-time schedule includes every other weekend or 4 weekend shifts per month • Weekend FT schedule available: 3 twelve-hour shifts, including one weekday shift • Pre-employment background check and drug screen provided at Netsmart’s sole expense