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

TWC Phoenix

Project Manager (Masonry & Waterproofing) Job at TWC Phoenix

 ...The Waterproofing Company, the Nation's oldest waterproofing company, and Phoenix Bay State Construction Company, Inc., a leader in masonry construction and restoration. Together, they offer a complete suite of waterproofing, masonry construction, and restoration... 

Island Enterprises, Inc.

Social Media Manager Job at Island Enterprises, Inc.

 ...creative and strategic Social Media Manager with proven cannabis marketing expertise. This role will lead digital storytelling, content...  ...Blueprint or Google Analytics Certification Bilingual English/Spanish skills Certificates & Licenses: None required, though... 

NIIT

Instructional Designer Job at NIIT

 ...75,000 days of training each year, in 18 languages. We have designed and developed over 50,000 days of classroom training and 20,0...  ...Website: Link for our LinkedIn page: Position - Instructional Designer Location - Princeton, New Jersey, United States... 

Mind Company

Machine Learning Intern Job at Mind Company

 ...forms, such as text. About the role As our Machine Learning Intern, you will be working on all our machine learning efforts, the...  ...will be communicating at higher information rates, playing video games with their mind, and never using slow keyboards again. All without... 

Related Ross

2026 Summer Analyst, Real Estate Development (Related Ross) Job at Related Ross

 ...vibrant and inclusive. With completed, in development and planned properties in West Palm...  ...is the most prominent privatelyowned real estate firm in the United States with major developments...  ...integral to our teams success. Interns work alongside some of the best minds...