Utilization Review Nurse
We are looking for a Full-time Utilization Review Nurse to join our Care Management team. This position is remote with evening/night and weekend availability from 4 pm – 12 am Pacific time.
This position requires concurrent review of emergency department admissions for a busy hospital. Utilization Review experience and knowledge of InterQual and/or Milliman criteria is required. Strong communication skills are essential
- Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual criteria.
- Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.
- Enter clinical review information into system for transmission to insurance companies for authorization.
- Bachelors of Science in Nursing or equivalent.
- Current state issued RN license.
- Minimum 3 years of case management/ concurrent review/ utilization management experience is required, preferably within the ED setting.
- Knowledge of InterQual and/or Milliman criteria is required.
- 5+ years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing.
- Proficiency in medical record review.
- Payer case management experience is a plus.
- Superior written communication skills.
- Proficiency with Microsoft Word is a must.
- Rebliable internet connectivity is required.