RN Utilization Review

PRIMARY PURPOSE

To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes.

ESSENTIAL RESPONSIBILITIES

• Performs clinical assessments via information in medical files; assesses injured employee’s situation which may include psychosocial needs.
• Evaluates patient condition including treatment utilization and compliance. Evaluates need for and recommends alternative treatment.
• Collaborate effectively with physicians, claims examiners, clients, vendors, supervisors and other parties as needed.
• Negotiates appropriate level and intensity of care through use of medical and disability guidelines, adhering to quality assurance standards.
• Acts as a resource in consulting with the client, nursing staff and claims examiners regarding treatment issues.
• Performs treatment utilization management reviews.
• Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.

EDUCATION AND LICENSING

• Active unrestricted RN license in a state or territory of the United States required.
• Compact licensure preferred.
• Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred.
• Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
• Two (2) years of direct clinical experience as an RN is required.

TAKING CARE OF YOU

• Sedgwick offers a diverse and comprehensive benefits package including medical, dental, vision, 401k, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
• The range of starting pay for this role is $63,000-$65,000/year.

WORK ENVIRONMENT REQUIREMENTS

• Physical: Computer keyboarding
• Auditory/visual: Hearing, vision and talking
• Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines