Utilization Review RN, Full-Time - Multiple Shifts Available

Netsmart is an industry-leading healthcare technology organization dedicated to empowering providers to deliver value-based care to individuals and communities. For more than 55 years, we have partnered with provider organizations to improve health and wellbeing across the communities we serve. Our innovative Netsmart CareFabric® platform offers a unified, connected framework of solutions and services designed for the human services, post-acute, payer and public sector communities. Together with our clients and Marketplace vendors, we develop and deliver technology solutions including electronic health records (EHRs), interoperability, analytics, augmented intelligence (AI), population health management and telehealth services that transform care delivery. With more than 2,600 associates, we work closely with over 754,000 users across the U.S. to automate and coordinate clinical, financial and administrative processes. Headquartered in Overland Park, KS, Netsmart has additional U.S. office locations in New York, Illinois and Missouri. As part of our continuous growth, we have launched the Netsmart India Global Capability Center (GCC) in Bengaluru, positioning it as a strategic hub to enhance our global presence, accelerate growth and foster collaboration. Together, we have positively impacted the lives of more than 147 million individuals.

Responsible for utilization review work for emergency 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