State Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse (PRN).

Key Responsibilities

Review and evaluate electronic medical records for emergency admissions to assess medical necessity

Apply clinical guidelines to ensure proper utilization of healthcare resources and participate in discussions with physicians

Enter clinical review information for insurance authorization and analyze utilization patterns

Required Qualifications

Current and unrestricted RN license

At least 3 years of clinical experience in an acute care setting

Minimum of 2 years of utilization management experience

Intermediate experience with InterQual and / or MCG criteria

Proficiency in medical record review in an electronic medical record (EMR) system