Job description

Responsible for utilization review work for emergency admissions and continued stay reviews.
Responsibilities

• Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria.

• Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.

• Enter clinical review information into system for transmission to insurance companies for authorization.

Qualifications
Required

• Current RN licensure

• At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing

• At least 3 years case management, concurrent review or utilization management experience

• Experience with InterQual and/or MCG criteria

• Proficiency in medical record review

Preferred

• Case management/concurrent review/utilization management experience within the ED setting

• Bachelors of Science in Nursing

Expectations

• This job operates in a remote environment that must be private. This role routinely uses standard office equipment such as computers, phones, and printers.

• Hours will vary, including two weekends a month.

• Must be able to remain in a stationary position 50% of the time and constantly operate a computer.

• Frequently communicates with internal, external and executive personnel and must be able to listen and exchange accurate information.

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.
Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider. Additionally, a positive result for marijuana will not automatically disqualify a candidate from employment if the individual can provide a valid prescription for medicinal use issued in his or her state of residence. A prescription is required even in states where recreational use has been legalized.
All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

Job Type: Part-time

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