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
Utilization Review Nurse (Workers Compensation) - Dallas
Utilization Review Nurse for Workers' Comp. Experience in Utilization Review, Workers Compensation is a plus. 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-b...
Utilization Review Nurse
A company is looking for a Utilization Review Registered Nurse to join their Clinical Review team. ...
Utilization Review Nurse-Remote-Contract
This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and medical and network management divisions. Provides informatio...
Utilization Review Nurse - RN
A company is looking for a Utilization Review Nurse for remote work. ...
Registered Nurse, Utilization Review - PRN Mon-Fri DAYS
Registered Nurse, Utilization Review - PRN Monday-Friday DAYS. Minimum of 5 years of experience to include 2 years of clinical experience and minimum of 3 years of recent Utilization Review experience. Current experience with utilizing a medical necessity tool to perform utilization reviews. Works c...
Registered Nurse Utilization Review - PRN
Registered Nurse Utilization Review. Minimum of 5 years of experience to include 2 years of clinical experience and minimum of 3 years of recent Utilization Review experience. Current experience with utilizing a medical necessity tool to perform utilization reviews. Works closely with decision suppo...
Registered Nurse (RN) - Utilization Review - $23+ per hour
Children's Health (Dallas) is seeking a Registered Nurse (RN) Utilization Review for a nursing job in Dallas, Texas. Department: Utilization Review. The Utilization Management Nurse is responsible for determining and managing medical necessity of acute inpatient admissions utilizing clinical criteri...
Travel Case Management (Utilization Review) RN (Registered Nurse) in Dallas, TX - 784121
Where will care take you? How about Dallas, TX?! This traveler-friendly facility is hiring a travel RN RN (Registered Nurse) to work in Case Management (Utilization Review). ...
Utilization Review Nurse Remote/Local
The Utilization Review Nurse (UR Nurse) performs medical necessity review of proposed, concurrent, or retrospective clinical services for injured workers in conjunction with specific state jurisdictional requirements. We are looking for a Utilization Review Nurse Remote/Local (Richardson, TX). Perfo...
Nurse Medical Case Manager - Workers' Compensation
Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse required. Claim, Nurse - Medical Case Manager. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Under moderate supervision, provide office b...