Utilization Review Nurse

About the role

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory requirements. This role reviews medical information submitted by treating providers, determines whether treatment can be authorized at the nurse level, and refers requests for physician review when additional clinical evaluation is required. This position is ideal for an experienced LPN with a strong clinical background who enjoys applying their medical knowledge in an analytical, process-driven environment. Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly valued. This is a hybrid position with two days per week in the office and three days remote. Candidates must also have flexibility to periodically work a later schedule to support business needs across multiple time zones.

Responsibilities

• Review medical treatment requests and supporting clinical documentation for adherence to applicable state guidelines and utilization review requirements
• Apply clinical knowledge and established guidelines to determine whether treatment requests can be authorized at the nurse level
• Refer treatment requests requiring additional clinical evaluation to physicians for review
• Evaluate medical records and treatment information to support timely and appropriate utilization review decisions
• Complete required documentation and administrative processing throughout the utilization review process
• Manage assigned reviews within applicable state-mandated and URAC turnaround requirements
• Accurately document treatment requests, clinical information, review activity, and determinations within client records
• Maintain confidentiality of medical and client information in accordance with HIPAA and applicable standards
• Collaborate with physicians, healthcare providers, claims professionals, and internal team members to facilitate the review process
• Maintain current clinical and industry knowledge relevant to utilization review and workers' compensation
• Provide responsive service while managing multiple reviews and competing deadlines

Requirements

• Active LPN license required
• Active multistate/compact nursing license required
• Strong clinical nursing experience with the ability to review medical records and evaluate treatment requests
• Ability to interpret medical terminology, treatment plans, and clinical documentation
• Ability to apply established clinical guidelines and determine when requests require physician review
• Flexibility to periodically work later hours to support business needs across multiple time zones
• Workers' compensation utilization review experience highly beneficial
• Utilization review or case management experience highly beneficial
• Clinical experience involving orthopedic or neurological conditions strongly preferred
• Strong organizational skills with the ability to prioritize a high volume of time-sensitive reviews
• Strong written and verbal communication skills
• Proficiency with Microsoft Office applications and ability to learn new clinical and claims systems

Qualifications

• Active Licensed Practical Nurse (LPN) license required
• Active multistate/compact nursing license required
• Additional utilization review, case management, workers' compensation, or related professional certifications beneficial

Benefits

At Acrisure, we offer a comprehensive suite of benefits and perks, including:

• Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.
• Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.
• Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.
• Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.

Schedule

This is a hybrid position with two days per week in the office and three days remote. Candidates must have flexibility to periodically work a later schedule to support business needs across multiple time zones.