Netsmart
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.
Responsible for utilization review work for emergency admissions and continued stay reviews.
Current RN licensure At least 3 years clinical experience in 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 in MS Office and basic Excel Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs Passing score(s) on job-related pre-employment assessment(s) Preferred: At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 3 years utilization management experience within the hospital setting Bachelors of Science in Nursing Proficient in InterQual/MCG criteria Case Management Certification (CCM, ACM, CMCN, or CMGT-BC 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.
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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.
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