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,