Part-time Remote Utilization Review Nurse

McBee - Remote

Part-time Utilization Review Nurse

We are looking for a Part-time Utilization Review Nurse to join our Care Management team. This position is remote with night and weekend availability. We are looking for availability between 4pm - 12am Pacific Standar Time.

Position Summary
This position requires concurrent review of emergency department admissions for a busy hospital. Utilization Review experience and knowledge of InterQual and/or Milliman criteria is required. Strong communication skills are essential.

Review electronic medical records of emergency department admissions and screen for medical necessity using InterQual criteria
Participate in telephonic discussions with emergency department physicians relative to documentation and admission status
Enter clinical review information into system for transmissions to insurance companies for authorization

Ability to work nights and weekends
Bachelors of Science in Nurse or equivalent
Current RN license
Minimum of 3 years of case management/concurrent review/utilization management experience is required, preferably within the ED setting
Knowledge of InterQual and/or Milliman criteria required
5+ years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
Proficiency in medical record review
Payer case management experience is a plus
Superior written communication skills
Proficiency with MS word a MUST
Reliable internet connectivity