Behavioral Health Utilization Review RN - Full-Time

Netsmart, a leading provider of Software as a Service (SaaS) technology and services solutions, designs, builds and delivers electronic health records (EHRs), health information exchanges (HIEs), analytics and telehealth solutions and services that are powerful, intuitive and easy-to-use. Our platform provides accurate, up-to-date information that is easily accessible to care team members in human services, post-acute care (which is comprised of home care and hospice and senior living) markets. We make the complex simple and personalized so our clients can concentrate on what they do best: provide services and treatment that support whole-person care. By leveraging the powerful Netsmart network, care providers can seamlessly and securely integrate information across communities, collaborate on the most effective treatments and improve outcomes for those in their care. Our streamlined systems and personalized workflows put relevant information at the fingertips of users when and where they need it. For more than 50 years, Netsmart has been committed to providing a common platform to integrate care. SIMPLE. PERSONAL. POWERFUL. Our more than 2,500 associates work hand-in-hand with our 680,000+ users at our clients across the U.S. to develop and deploy technology that automates and coordinates everything from clinical to financial to administrative. Learn more about how Netsmart is changing the face of healthcare today. Visit www.ntst.com, call 1-800-472-5509, follow us on our CareThreads Blog, LinkedIn and Twitter, like us on Facebook or visit us on YouTube. Netsmart is pleased to support the EveryDayMatters® Foundation, which was established for behavioral health, care at home, senior living and social services organizations to learn from each other and share their causes and stories.

Responsible for utilization review work for behavioral health admissions and continued stay reviews.

Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources 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 Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources