Utilization Management Nurse

Responsibilities:

• Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria.
• Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources.
• Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.

Qualifications:

• Current and unrestricted RN license with at least 3 years clinical experience in acute care setting (ER, critical care, or med/surg).
• At least 2 years utilization management experience in acute admission and concurrent reviews.
• Intermediate level experience with InterQual and/or MCG criteria within the last two years.

Expectations:

• Comfortable with remote work arrangements and virtual collaboration tools.
• Physical demands include extended periods of sitting, computer use, and telephone communication.
• Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs.