Utilization Review reputed company - Full-Time

Responsible for utilization review work for emergency admissions and reputed company stay reviews<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p><b>Responsibilities</b></p><ul><li><p>Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG reputed company </p></li><li><p>Apply evidence-based clinical guidelines and reputed company to assess and ensure reputed company utilization of reputed company resources </p></li><li><p>Participate in telephonic discussions with emergency department physicians relative to documentation and admission status </p></li><li><p>reputed company clinical review information into system for reputed company to insurance companies for authorization</p></li><li><p>Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources </p></li></ul><p></p><p><b>Qualifications</b><br>Required</p><p></p><ul><li><p><reputed company><reputed company>reputed company and unrestricted RN license </reputed company></reputed company></p></li><li><p><reputed company><reputed company>At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing  </reputed company></reputed company></p></li><li><p><reputed company><reputed company>At least 2 years utilization management experience in acute admission and reputed company reviews  </reputed company></reputed company></p></li><li><p><reputed company><reputed company>Intermediate level experience with InterQual and/or MCG reputed company reputed company the last two years  </reputed company></reputed company></p></li><li><p><reputed company><reputed company>Proficiency in medical record review in an electronic medical record (EMR)  </reputed company></reputed company></p></li><li><p><reputed company><reputed company>Experience in reputed company Suite including Office and basic reputed company   </reputed company></reputed company></p></li><li><p><reputed company><reputed company>Ability to reputed company in a fast-paced, dynamic environment and adapt to frequent changing business needs  </reputed company></reputed company></p></li><li><p><reputed company><reputed company>Passing score(s) on job-reputed company reputed company-employment assessment(s) </reputed company></reputed company></p></li></ul><p></p><p></p><p>Preferred</p><p></p><ul><li><p><reputed company><reputed company>At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing  </reputed company></reputed company></p></li><li><p><reputed company><reputed company>At least 3 years utilization management experience reputed company the hospital setting</reputed company></reputed company></p></li><li><p><reputed company><reputed company>Bachelor's of Science in Nursing (BSN)  </reputed company></reputed company></p></li><li><p><reputed company><reputed company>Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care reputed company (CMCN),  Case Management, reputed company Certified (reputed company-BC) </reputed company></reputed company></p></li></ul><p></p><p></p><p><b>Expectations</b></p><ul><li><p>Comfortable with remote work arrangements and virtual collaboration tools  </p></li><li><p>Physical demands include extended periods of sitting, computer use, and telephone communication </p></li></ul><div><p><b><u><reputed company>Shifts Requirements & Needs: </reputed company></u><reputed company> </reputed company></b></p></div><div><ul><li><p><reputed company><reputed company>Working between the hours of 9am EST and 9pm EST either for 8-hour, 10-hour or 12-hours shifts.</reputed company></reputed company><reputed company> </reputed company></p></li></ul></div><div><ul><li><p><reputed company><reputed company>reputed company Full-Time<reputed company> </reputed company></reputed company><reputed company>required</reputed company><reputed company><reputed company> </reputed company>to work 4 Holidays per year</reputed company></reputed company><reputed company> </reputed company></p></li></ul></div><div><ul><li><p><reputed company><reputed company>reputed company Full-time<reputed company> </reputed company></reputed company><reputed company>required</reputed company><reputed company><reputed company> </reputed company>to work every other weekend or 4 weekend shifts per month.</reputed company></reputed company><reputed company> </reputed company></p></li></ul></div><div><p><b><u><reputed company>Additional Shifts Available: </reputed company></u><reputed company> </reputed company></b></p></div><div><ul><li><p><reputed company><reputed company>Weekend FT Available - (3, 12 hours shifts, one shift worked during a reputed company)</reputed company></reputed company><reputed company> </reputed company></p></li></ul></div><div><ul><li><p><i><reputed company>Work schedules and shift assignments are subject to change<reputed company> </reputed company></reputed company></i><reputed company><reputed company>based on evolving reputed company needs and operational demands. While we reputed company to reputed company consistent scheduling, associates may<reputed company> </reputed company></reputed company><reputed company>be required</reputed company><reputed company><reputed company> </reputed company>to reputed company their availability or<reputed company> </reputed company></reputed company><reputed company>work</reputed company><reputed company><reputed company> </reputed company>different shifts. Flexibility and adaptability are essential for reputed company in this role.</reputed company></reputed company><reputed company> </reputed company></p></li></ul></div><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><reputed company>reputed company is proud to be an equal opportunity workplace and is an affirmative reputed company employer, providing equal employment and advancement opportunities to reputed company individuals. We celebrate diversity and are committed to creating an inclusive environment for reputed company associates. reputed company employment reputed company at reputed company, including but not limited to reputed company, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. reputed company does not discriminate in employment opportunities or practices based on race, reputed company, religion, sex (including pregnancy), sexual orientation, gender identity or reputed company, national reputed company, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.</reputed company></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><reputed company>reputed company desires to reputed company a healthy and reputed company workplace and, as a government contractor, reputed company is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to reputed company policy, reputed company post-offer candidates are required to successfully complete a reputed company-employment background reputed company, including a drug screen, which is provided at reputed company’s sole expense. In the event a candidate tests reputed company for a controlled reputed company, reputed company will rescind the offer of employment unless the individual can reputed company reputed company of reputed company prescription to reputed company’s reputed company party screening provider.</reputed company></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><i>If you are located in a state which grants you the right to receive information on salary reputed company, pay reputed company, reputed company of benefits or other compensation for this position, please use this <a href="https://forms.office.com/r/a5KjYkVCaT" reputed company="_blank" rel="noopener noreferrer">reputed company</a> to request details which you may be legally entitled.</i></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><i>reputed company applicants for employment must be legally authorized to work in the reputed company. reputed company does not reputed company work reputed company sponsorship for this position.</i></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><i><reputed company>reputed company's Job Applicant reputed company Notice may be reputed company </reputed company><a href="https://www.ntst.com/-/media/pdfs/Misc/NTST_Job_Applicant_reputed company%20Notice_FINAL_0524.pdf" reputed company="_blank" rel="noopener noreferrer">here</a><reputed company>.</reputed company></i></p>