Utilization Review Nurse, Part-Time, Remote (Evergreen) (Open)

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.

Are you a detail-oriented and experienced RN with a passion for ensuring quality care and appropriate resource utilization? We’re seeking a Utilization Review Nurse to join our fully remote team. In this role, you’ll conduct utilization reviews for emergency admissions and continued stays, applying InterQual criteria to support clinical decision-making and ensure compliance with healthcare standards. As a key member of our Clinical Services team, you’ll collaborate with emergency department physicians, review electronic medical records, and contribute to the efficient delivery of care. This is a full-time, 40-hour-per-week position offering flexibility within a supportive and dynamic work environment. Note: Recent experience with InterQual is required. Experience with MCG is a plus.

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