- Case Management
- Utilization Management
- Microsoft Word
- Medical Records
- Communication Skills
This position requires concurrent review of emergency department admissions for a busy hospital.
Essential Duties and Responsibilities
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 transmission to insurance companies for authorization.
Bachelors of Science in Nursing or equivalent
Current RN licensure
Specialized skills and knowledge
Constant contact with all levels within McBee Associates requiring resourcefulness, tact, diplomacy, problem resolution and ability to maintain strict confidentiality.
Payer case management experience is a definite plus
Superior written communication skills
Proficiency with MS Word
Reliable internet connectivity is required
Minimum of 3 years case management/concurrent review/utilization management experience is required, preferably within the ED setting. Knowledge of InterQual criteria also required.
5+ years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing• Proficiency in medical record review
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Must be able to work extended hours beyond 8 a.m. to 5 p.m. Monday-Friday. Must be able to remain in a stationary position 50% of the time and constantly operate a computer. Must be able to move to various meeting locations. Frequently communicates with internal, external and executive personnel and must be able to listen and exchange accurate information.
Netsmart provides equal employment and advancement opportunities to all individuals. Employment decisions at Netsmart will be based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, physical or mental disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws. Netsmart complies with any applicable state and local laws governing nondiscrimination in employment.