State Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse, Full-Time (9a-9p EST), Remote. Key Responsibilities Review and evaluate electronic medical records for emergency department admissions to assess medical necessity Apply clinical guidelines to ensure proper utilization of healthcare resources and participate in discussions with emergency department physicians Enter clinical review information into the system for insurance authorization and analyze utilization patterns and trends Required Qualifications Current and unrestricted RN license At least 3 years of clinical experience in an acute care setting, particularly in emergency room, critical care, or medical/surgical nursing At least 2 years of utilization management experience in acute admission and concurrent reviews Intermediate experience with InterQual and/or MCG criteria within the last two years Proficiency in medical record review in an electronic medical record (EMR) system

May 5, 2025 - 16:22

A company is looking for a Utilization Review Nurse, Full-Time (9a-9p EST), Remote. Key Responsibilities Review and evaluate electronic medical records for emergency department admissions to assess medical necessity Apply clinical guidelines to ensure proper utilization of healthcare resources and participate in discussions with emergency department physicians Enter clinical review information into the system for insurance authorization and analyze utilization patterns and trends Required Qualifications Current and unrestricted RN license At least 3 years of clinical experience in an acute care setting, particularly in emergency room, critical care, or medical/surgical nursing At least 2 years of utilization management experience in acute admission and concurrent reviews Intermediate experience with InterQual and/or MCG criteria within the last two years Proficiency in medical record review in an electronic medical record (EMR) system