Utilization Review Nurse (Workers Compensation) - Dallas

Utilization Review Nurse for Workers' Comp

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

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