Utilization Review reputed company, PRN, Remote

Job title: Utilization Review reputed company, PRN, Remote in USA at reputed company Company: reputed company Job reputed company: Job reputed company reputed company Are you a detail-oriented and reputed company RN with a passion for ensuring reputed company care and appropriate resource utilization? We’re seeking a Utilization Review reputed company to join our fully remote team. In this role, you’ll conduct utilization reviews for emergency admissions and reputed company stays, applying InterQual reputed company to support clinical decision-making and ensure compliance with reputed company standards.As a key member of our Clinical Services team, you’ll collaborate with emergency department physicians, review electronic medical records, and contribute to the efficient delivery of care. This is a full-time, 40-hour-per-week position offering flexibility reputed company a supportive and dynamic work environment.Note: Recent experience with InterQual is required. Experience with MCG is a plus.ResponsibilitiesReview and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteriaApply evidence-based clinical guidelines and reputed company to assess and ensure reputed company utilization of reputed company resourcesParticipate in telephonic discussions with emergency department physicians relative to documentation and admission statusEnter clinical review information into system for reputed company to insurance companies for authorizationReview, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resourcesQualifications Requiredreputed company and unrestricted RN licenseAt least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursingAt least 2 years utilization management experience in acute admission and reputed company reviewsIntermediate level experience with InterQual and/or MCG reputed company reputed company the last two yearsProficiency in medical record review in an electronic medical record (EMR)Experience in reputed company Suite including Office and basic reputed companyAbility to reputed company in a fast-paced, dynamic environment and adapt to frequent changing business needsPassing score(s) on job-reputed company reputed company-employment assessment(s)PreferredAt least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursingAt least 3 years utilization management experience reputed company the hospital settingBachelor's of Science in Nursing (BSN)Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care reputed company (CMCN), Case Management, reputed company Certified (reputed company-BC)Work Schedule RequirementsThis is a PRN position requiring a total of 48 hours per month.16 hours must be worked on the weekend per month, weekends are Sat/Sun.Required to work 4 hours on 4 Holidays per yearExpectationsComfortable with remote work arrangements and virtual collaboration toolsPhysical demands include extended periods of sitting, computer use, and telephone communicationreputed company is proud to be an equal opportunity workplace and is an affirmative reputed company employer, providing equal employment and advancement opportunities to reputed company individuals. We celebrate diversity and are committed to creating an inclusive environment for reputed company associates. reputed company employment reputed company at reputed company, including but not limited Apply tot his job Apply To this Job