New York RN Utilization Reviewer

Job Summary

To enhance the quality of healthcare, the RN Utilization Reviewer (Workers' Compensation) will perform independent external medical reviews remotely as an independent contractor, applying clinical expertise to evaluate cases for medical necessity and standard of care.

Key responsibilities

• Review treatment requests and medical records for medical necessity and guideline compliance
• Apply Workers' Compensation Medical Treatment Guidelines and regulatory requirements
• Prepare clear, objective, and timely review determinations while maintaining confidentiality

Required qualifications

• Active, unrestricted RN license; New York RN license strongly preferred
• Minimum of three years of experience in workers' compensation, utilization review, case management, or occupational health
• Working knowledge of Workers' Compensation Medical Treatment Guidelines and evidence-based clinical criteria
• Experience reviewing medical records and determining medical necessity preferred
• Strong clinical assessment and critical thinking skills