Job Details
Utilization Review Nurse
Posted: 03/10/2019
Position: Full Time
About This Job:
We are looking for a Utilization Review Nurse to aide in our growing Workers’ Compensation line of business. Nurses with experience in Utilization Review and Workers’ Compensation are preferred.
The Utilization Review Nurse performs an integral role in our clinical prep service by summarizing medical records and applying appropriate guidelines in conjunction with clinical expertise to craft an evidence-based rationale for the provision of Workers’ Compensation services. This individual must possess the ability to work independently under deadlines and should be well-versed in state-specific guidelines as well as nuances within the Workers’ Compensation industry. This role is completely telephonic through the use of our web portal.
Roles & Responsibilities:
  • Review Workers’ Compensation treatment requests for specialties including Orthopedic Surgery, Physical Medicine and Rehabilitation, Physical Therapy, Family Practice, Emergency Medicine, Neurology and Anesthesiology.
  • Provide concise and accurate medical summaries according to client-specific templates and utilize appropriate guidelines in order to provide rationales that are based on guidelines and/or evidence-based literature.
  • Ensures all summaries are edited to client standards and are free from grammatical and clerical errors.
  • Perform quality assurance to ensure client supplied guidelines and requests are appropriate with jurisdictional requirements and/or requests in question.
  • Possess the ability to perform same day turnaround reviews.
  • Highlight inconsistencies within documentation in order to support or refute determinations previously supplied by clients.
Requirements & Qualifications:
  • USRN, LVN or equivalent licensure (any state)
  • Passing of NCLEX Examination
  • At least one year of experience in the Workers’ Compensation/Utilization Review industry
  • Proficiency with state-specific guidelines and the ability to research relevant literature (ACOEM, ODG, etc.)
  • Proficiency with Google Chrome, Microsoft Office and/or Nuance programs
  • Strong oral and written communication skills
Skills Required:
Writing & Content
Content Writing Level 4
Article Writing Level 4
English Proofreading Level 4