Utilization Review Nurse (Healthcare)

Location: Remote within the United States; applicants must be legally authorized to work in the United States. Working hours are between 9am EST and 9pm EST, with 8-, 10-, or 12-hour shifts. Full-time schedules include four holidays per year and every other weekend or four weekend shifts per month.

Company

hirify.global provides healthcare technology and services.

What you will do

• Review electronic medical records for emergency department admissions and continued stays.
• Assess medical necessity using InterQual or MCG criteria and evidence-based clinical guidelines.
• Discuss documentation and admission status with emergency department physicians by telephone.
• Enter clinical review information for transmission to insurance companies and authorization processing.
• Analyze utilization patterns, trends, problems, and inappropriate use of healthcare resources.

Requirements

• Current, unrestricted RN license and legal authorization to work in the United States.
• At least three years of acute-care clinical experience in emergency, critical care, and/or medical-surgical nursing.
• At least two years of utilization management experience with acute admission and concurrent reviews.
• Intermediate-level experience with InterQual and/or MCG criteria within the last two years.
• Experience reviewing medical records in an electronic medical record system and using Microsoft Office and basic Excel.
• Successful completion of job-related pre-employment assessments.

Nice to have

• At least five years of acute-care clinical experience.
• At least three years of hospital-based utilization management experience.
• Bachelor of Science in Nursing degree.
• Case management certification such as CCM, ACM, CMCN, or CMGT-BC.

Culture & Benefits

• Remote work with virtual collaboration tools.
• Flexible availability is required because schedules and shift assignments may change based on client and operational needs.
• Physical demands include extended sitting, computer use, and telephone communication.
• Background check and drug screening are required after an offer.
• hirify.global provides equal employment opportunities and maintains a drug-free workplace.