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Utilization Review Nurse (Fully Remote - Day Shift

at Netsmart in Leawood, Kansas, United States

Job Description

Are you an RN with a passion to help improve the quality of patient care without working bedside? Do you have at least five years of bedside experience within an emergency room, critical care, or med/surg setting? Do you have at least a couple years of experience doing concurrent utilization review within an acute inpatient setting? Are you seeking an opportunity to work in your home on a team with other dedicated clinicians in an organization focused on achieving the best outcomes?

McBee Associates, a leader in clinical advisory services, is growing and adding to our remote team of Utilization Review Nurses focused on admissions and continued stay reviews. With the shift to value-based and patient-centered care, McBee has become the company health systems rely upon to ensure care management plans are effective and accurate. We take a partnership approach in care coordination with our clients that results in accurate patient status and reduced denials. Submit your application today and talk with us about the possibilities of working with McBee, a Netsmart company.

Responsibilities

As a remote associate working from home, it is important you have an office that provides the privacy needed for your critical work. Your reviews start at the point of admission, verifying that documentation meets medical necessity requirements utilizing hospitals' approved evidence-based criteria, identifying missing and insufficient documentation. You will work with physicians on their plan of care and documentation to support the appropriateness of the level of care ordered. The work you do helps hospitals and health systems improve care efforts throughout their organization and increase their cash flow.

Qualifications
Active RN licensure in your state of residency with at least 5 years' clinical experience in an acute care setting in Emergency Department, Critical Care, or Medical/Surgical Care.
At least 3 years' experience in utilization review within an inpatient acute care setting.
Experience with Milliman Clinical Guidelines (MCG) is a must and any experience with Interqual is a plus.
Associates are required to work two weekends per month and three holidays per year.

#Remote - Other
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Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

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Job Posting: 12090506

Posted On: Jun 23, 2022

Updated On: Jun 23, 2022