Utilization Review Nurse
Job Summary
To enhance the quality of care in workers' compensation, the full-time Utilization Review Nurse will assess medical necessity, analyze data, and coordinate communication among all parties involved, working remotely during standard business hours.
Key responsibilities
- Perform comprehensive evaluations of medical data to assess medical necessity
- Coordinate information and discuss care plans with insurance representatives and other stakeholders
- Participate in annual audits to ensure compliance with established guidelines
Required qualifications
- Graduate of an accredited nursing, chiropractic, or related medical program (RN, DC, PT, DPT, LVN, OT, or LAc)
- Valid state-specific license in good standing with no restrictions
- Experience in Utilization Review or Workers' Compensation is preferred
- Strong organizational skills and proficiency in computer programs (MS Word, MS Excel, Email)
- Ability to work independently and meet deadlines in a high-pressure environment
Complete Job Description
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