Remote
McBee Associates, Inc.

Utilization Review Nurse

Full-Time, Remote

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.

Position Summary

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

Responsibilities:

  • 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.

Requirements:

  • 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.