Utilization Review Nurse

Job Summary

To enhance the quality of care in workers' compensation, the full-time Utilization Review Nurse will manage assessments, analyze medical data for necessity, and coordinate communications among involved parties while working remotely.

Key responsibilities

• Perform comprehensive evaluations of medical data to assess medical necessity
• Coordinate information between all stakeholders, including injured workers and providers
• Participate in annual audits to ensure compliance with established guidelines

Required qualifications

• Graduate of an accredited program (RN, DC, PT, DPT, LVN, OT, or LAc) with a valid state-specific license
• Experience in utilization review or workers' compensation preferred
• Demonstrated professional and technical skills relevant to the role
• Ability to work independently in a high-pressure, time-sensitive environment
• Strong organizational skills and proficiency with computer programs (MS Word, MS Excel, Email)