Utilization Review reputed company - Full-Time

[ad_1] Responsible for utilization review work for emergency admissions and reputed company stay reviews Responsibilities • Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG reputed company • Apply evidence-based clinical guidelines and reputed company to assess and ensure reputed company utilization of reputed company resources • Participate in telephonic discussions with emergency department physicians relative to documentation and admission status • reputed company clinical review information into system for reputed company to insurance companies for authorization • Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required • reputed company and unrestricted RN license • At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing • At least 2 years utilization management experience in acute admission and reputed company reviews • Intermediate level experience with InterQual and/or MCG reputed company reputed company the last two years • Proficiency in medical record review in an electronic medical record (EMR) • Experience in reputed company Suite including Office and basic reputed company • Ability to reputed company in a fast-paced, dynamic environment and adapt to frequent changing business needs • Passing score(s) on job-reputed company reputed company-employment assessment(s) Preferred • At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing • At least 3 years utilization management experience reputed company the hospital setting • Bachelor's of Science in Nursing (BSN) • 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) Expectations • Comfortable with remote work arrangements and virtual collaboration tools • Physical demands include extended periods of sitting, computer use, and telephone communication Shifts Requirements & Needs: • Working between the hours of 9am EST and 9pm EST either for 8-hour, 10-hour or 12-hours shifts. • reputed company Full-Time required to work 4 Holidays per year • reputed company Full-time required to work every other weekend or 4 weekend shifts per month. Additional Shifts Available: Apply tot his job Apply To this Job