Utilization Review Nurse (REMOTE) Job at Elite, Remote

cS82MHljYXJzaFp3bkZwQ3dCcnJqN0JpeGc9PQ==
  • Elite
  • Remote

Job Description

Utilization Review Nurse for Workers' Compensation - Injured Workers

Job Purpose:
Review Workers Compensation requests submitted by the provider, requestor, claimant or carrier to determine the medical necessity of the treatment utilizing clinical expertise and evidence-based treatment guidelines.

Duties:
  • Perform an evaluation of the medical data for utilization review requests.
  • Confirm accurate completion of data intake.
  • Collect additional relevant data as needed with regard to determining medical necessity.
  • Analyze the collected data to apply evidence-based guidelines.
  • Review requests and make certification decisions, when appropriate, or prepare a case for peer review referral.
  • Coordinates information between all parties (injured worker, physicians, employer, therapists, attorney, etc)
  • Participate in audits of work product to ensure compliance.
  • Monitor daily processing inventory, including rush/urgent requests.
  • Provide inventory information and raise concerns to clinical director.
  • Complete production logging.
  • Assist leadership team with training and coordinating back-up resources.
Requirements/Skills/Qualifications:
  • Graduate of an accredited school
  • Valid current RN license in good standing
  • Able to perform the professional and technical skills of a Registered Nurse
  • Minimum 2 years of direct patient care
  • Excellent, written and oral communication skills
  • Ability to read and interpret medical reports and treatment guidelines
  • Must be able to maintain confidentiality
  • Must possess strong personal organizational skills
  • Must have experience and knowledge of intermediate computer skills
  • Ability to work independently with little to no supervision
  • Ability to work in a fast-paced and time-sensitive environment
  • Ability to meet deadlines in a production driven environment
  • Ability to work with WORD and EXCEL documents.
Preferences:
  • Experience in Utilization Review, Workers Compensation is a plus

Job Tags

Remote work,

Similar Jobs

MetaPhase Consulting

Drupal Developer Job at MetaPhase Consulting

 ...advantage of every opportunity available to you? Be the difference and make it happen? MetaPhase is seeking an experienced Drupal Developer to join a federal IT modernization team responsible for enhancing and maintaining a mission?critical public?facing website.... 

Fath Properties

Apartment Maintenance Technician Job at Fath Properties

 ...tasks: Repairs in make ready residential units such as cabinet removal and replacement, appliance removal and replacement, tub and tile removal and replacement, Plumbing repairs, electrical repairs, vinyl flooring install, Lighting replacement, Hardware... 

Kelly

BSL3/4 Animal Biologist Job at Kelly

 ...centers, biotechnology and pharmaceutical development companies in the world. We are seeking individuals qualified to work as a BSL3/4 Animal Biologist to support the mission of the National Institutes of Health (NIH). This is a long-term contract position which offers... 

ADEX Healthcare Staffing LLC

Travel Registered Nurse - Med Surg Job at ADEX Healthcare Staffing LLC

 ...Job Description ADEX Healthcare Staffing LLC is seeking a travel nurse RN Med Surg for a travel nursing job in Saint Louis, Missouri. Job Description & Requirements ~ Specialty: Med Surg ~ Discipline: RN ~ Start Date: ASAP ~ Duration: 13 weeks ~36 hours... 

Randstad

Tool and mold maker Job at Randstad

 ...We are looking for a highly skilled Tool and Mold Maker to join our precision manufacturing team in Riverside, CA. This role requires extensive experience in custom injection molding and the ability to fabricate, maintain, and repair complex molds. The ideal candidate...