Utilization Review Nurse (REMOTE) Job at Elite, Remote

MjJDMlBQRUtPVTVweHFGdTA2M1U4S1k1ckE9PQ==
  • 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

Similar Jobs

Carelinks ABA

Board Certified Behavioral Analyst (BCBA) Job at Carelinks ABA

 ...initiatives that drive client satisfaction, growth, and efficiency.What Youll Need:~ Current Board Certified Behavior Analyst (BCBA) certification and state licensure in good standing.~ Master's degree in Applied Behavior Analysis, Education, Psychology, or a... 

Precision Medical Group, Inc

Physiatrist/PM&R & Neurologists for EMG/NCS testing Job at Precision Medical Group, Inc

 ...Physiatrist/PM&R & Neurologists forEMG/NCS testing $400 to $600 per hour or to be negotiated - Part-time Job details Precision Occupational Medical Group, Inc. (Precision) Precision is one of Californias leading providers of high-quality EMG/NCS testing services... 

TSR Consulting

DevOps Team Lead Job at TSR Consulting

 ...Our client is hiring a DevOps Team Lead on a direct full time basis. Job ID: 83523 Work Location: Naples, FL - on site position - candidates must relocate if not local (relocation assistance available) Summary: Summary: We are looking for a talented... 

The Venetoulis Institute for Local Journalism

Copy Editor Job at The Venetoulis Institute for Local Journalism

 ...About the Job: The Banner is hiring a copy editor to become our last line of defense against errors, lack of clarity, confusing language...  ...respect. The copy editor will have some flexibility to work remotely. Their schedule will depend on newsroom needs, though they'll... 

Twice

Golf Course Superintendent Job at Twice

Overview As the Golf Course Superintendent at Juday Creek, your primary responsibility will be to oversee the maintenance of the golf course grounds, practice areas, and clubhouse facilities to uphold the quality of excellence of Juday Creek. You will work closely with...