Utilization Review Nurse - RN - Racine Wisconsin

Company: VirtualVocations
Location: Racine, Wisconsin
Posted On: 11/21/2024

A company is looking for a Utilization Review Nurse to perform utilization review work for emergency admissions and continued stay reviews.



Key Responsibilities

Review electronic medical records of emergency department admissions for medical necessity using InterQual or MCG criteria
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


Required Qualifications

Current RN licensure
At least 3 years of clinical experience in an acute care setting (emergency room, critical care, or medical/surgical nursing)
At least 2 years of 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) More...

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