Job Description
Utilization Review Nurse for Workers' Comp Office Location - Montgomery County Area 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. • *Please note that this is an In-office position. 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 Apply tot his job