Job Description:
• Review and evaluate electronic medical records of emergency department admissions
• Screen admissions 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 regarding documentation and admission status
• Enter clinical review information into the system for transmission to insurance companies for authorization
• Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources
Requirements:
• Current and unrestricted RN license
• At least 3 years (36 months) clinical experience in an acute care setting in emergency room, critical care and/or medical/surgical nursing
• 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
• Proficiency in medical record review in an electronic medical record (EMR)
• Experience with Microsoft Suite, including Office and basic Excel
• Ability to thrive in a fast-paced, dynamic environment and adapt to frequently changing business needs
• Passing score(s) on job-related pre-employment assessment(s)
• All applicants must be legally authorized to work in the United States
• Netsmart does not provide work visa sponsorship for this position
• Comfortable with remote work arrangements and virtual collaboration tools
• Physical demands include extended periods of sitting, computer use, and telephone communication
• Preferred: at least 5 years clinical experience in an acute care setting
• Preferred: at least 3 years utilization management experience within the hospital setting
• Preferred: Bachelor of Science in Nursing (BSN)
• Preferred: case management certifications such as CCM, ACM, CMCN, or CMGT-BC
Benefits:
• Remote work arrangements
• Virtual collaboration tools
• Pre-employment background check and drug screen provided at Netsmart’s sole expense
• Equal employment and advancement opportunities
• Inclusive workplace environment