RN Utilization Review

By joining Sedgwick, you’ll be part of something meaningful—what our 33,000 colleagues do every day for people facing the unexpected. Grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

About the role

As a nurse at Sedgwick, you can build a meaningful and rewarding career while advocating for patients in a nontraditional clinical setting. Apply your RN clinical knowledge and experience to assist in the management of complex medical conditions, treatment planning, and recovery from illness or injury. Work in the best of both worlds—a rewarding career making an impact on health and well-being in a remote environment. Enjoy flexibility and autonomy while advocating for effective and efficient medical treatment for injured employees. Enable Sedgwick’s Caring Counts® mission of supporting injured employees from some of the world’s best brands. Be part of a rapidly growing, industry-leading global company known for excellence and customer service. Celebrate career achievements through professional development, continuing education, and team-building initiatives.

Responsibilities

• Performs clinical assessments via information in medical files; assesses injured employee’s situation, including psychosocial needs.
• Evaluates patient condition, including treatment utilization and compliance; evaluates need for and recommends alternative treatment.
• Collaborates 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 clients, nursing staff, and claims examiners regarding treatment issues.
• Performs treatment utilization management reviews.
• Maintains client privacy and confidentiality; promotes client safety and advocacy; adheres to ethical, legal, accreditation, and regulatory standards.

Requirements

• Active unrestricted RN license in a state or territory of the United States (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 (highly preferred).
• Two (2) years of direct clinical experience as an RN (required).

Benefits

We offer a diverse and comprehensive benefits package beginning your first day, including:

• Medical, dental, and vision coverage.
• 401(k) with company matching.
• Paid time off (PTO).
• Disability and life insurance.
• Employee assistance program.
• Flexible spending or health savings account.
• Additional voluntary benefits.

Pay

For the jurisdiction noted in this job posting, the range of starting pay for this role is $63,000–$65,000 per year.

Work environment

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