Utilization Reviewer 2

About the role

This is an In Office Position from Monday - Friday from 9 AM - 5 PM CST. MO Registered Nurse Or Chiropractor License Required. We are seeking a qualified Utilization Reviewer located in the Tampa, FL area. The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in assessing and ensuring the appropriateness of medical treatment plans, contributing to effective claims management and optimal patient outcomes.

Responsibilities

• Uses solid clinical judgment to ensure treatment approved is medically necessary.
• Forwards treatment requests for physician reviewer that cannot be approved as medically necessary based on application of solid clinical judgment.
• Collaborates with healthcare providers, claims adjusters, and other stakeholders to gather relevant information for comprehensive assessments.
• Evaluates medical documentation to ensure compliance with industry standards and regulatory requirements.
• Communicates findings clearly and concisely through written reports and verbal discussions.
• Stays up-to-date on industry regulations, medical advancements, and best practices to enhance the quality of reviews.
• Participates in team meetings and contributes to the continuous improvement of utilization review processes.

Qualifications

Minimum Education: Bachelor's degree.

Required Skills and Experience

• Registered Nurse (RN) or LVN with a valid license in the state of practice.
• Minimum of 2 years of clinical experience; or an advanced degree without experience.
• Knowledge of medical terminology, treatment modalities, and healthcare guidelines.
• Analytical and critical thinking skills for effective decision-making.
• Strong communication and interpersonal skills to liaise with diverse stakeholders.
• Ability to work independently and collaboratively within a team environment.
• Detail-oriented with strong organizational skills to manage multiple cases efficiently.
• Familiarity with relevant software and tools used in healthcare.

Desired Skills and Experience

• Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity.
• Prior experience in the workers' compensations field.

Benefits

• Medical, Dental, Vision
• Health Savings Accounts / Flexible Spending Accounts
• Life and AD&D Insurance
• 401(k)
• Tuition Reimbursement
• An array of resources that encourage a lifetime of healthier living

Benefits eligibility may differ depending on full-time or part-time status.

Pay

The expected base pay for this position ranges from $52,750 - $76,000 annually, and will be based on a number of additional factors including skills, experience, and education.