Staff Nurse - Utilization Review (ED)

SUMMARY :

We are currently seeking a Staff Nurse to join our Utilization Management department for the / Emergency Department /

This position is a 0.6 FTE (6 shifts / pay period), 8-hour shifts, Days, with up to Every Other Weekend rotation. Note : Note : / C / / urrent weekend assignment is typically every 2-3 weeks however is subject to change based on staffing needs and may require up to Every Other Weekend coverage / .

SPECIFIC RESPONSIBILITIES :

The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. The RN conducts timely reviews of inpatient and outpatient medical records to determine the appropriateness of admissions, continued stays, and the level of care using established criteria and guidelines (e.g., InterQual, MCG). This role collaborates with healthcare providers, patients, payers, and internal departments to ensure quality care while optimizing resource utilization and controlling costs. /

Assessment :

• Collects, reviews, and documents clinical data relevant to utilization management, including patient status, treatment plans, and healthcare utilization. Applies nationally recognized criteria (e.g., InterQual, MCG) to assess the appropriateness of services

Outcomes Identification :

Planning :

Implementation :

Evaluation :

Quality of Practice :

Education :

Professional Practice :

Collegiality :

Collaboration :

Ethics :

Evidence-Based Nursing Practice and Nursing Research :

Resource Utilization :

Leadership :

Self-Evaluation :

Safe Practice :

Provide Education and Mentorship :

QUALIFICATIONS :

/ Minimum Qualifications : /

/ Preferred Qualifications : /

Bachelor’s degree in nursing

Certification in area of clinical specialty

Minimum 2 years of recent clinical experience (e.g., med / surg, ICU, ED, or case management)

Strong understanding of utilization review / utilization management principles

Familiarity with InterQual, MCG, or similar clinical decision-making tools

Excellent critical thinking, communication, and documentation skills

Proficiency with EMRs and healthcare documentation systems

BSN Preferred. Bachelor of Nursing degree is strongly encouraged. Advancement in academic education will be discussed as part of individual professional development during the annual performance review

/ License / Certifications : /

Title : Staff Nurse - Utilization Review (ED)

Location : MN-Minneapolis-Downtown Campus

Requisition ID : 251531