Utilization Reviewer 2

About the role

This is an In Office Position from Monday - Friday from 9 AM - 5 PM EST.

Responsibilities

• Performs utilization review on workers’ compensation related prospective, concurrent, and retrospective treatment referrals.
• Affirms the appropriateness of medical treatment plans, contributing to effective claims management and optimal patient outcomes.
• 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.

Requirements

• Minimum Education: Bachelor's degree.
• Required Skills and Experience:
  • Registered Nurse (RN) or chiropractor with a valid license in the state of Florida.
  • Minimum of 2 years of utilization review 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.

Qualifications

• Minimum Education: Bachelor's degree.
• Required Skills and Experience:
  • Registered Nurse (RN) or chiropractor with a valid license in the state of Florida.
  • Minimum of 2 years of utilization review 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.

Skills

• Utilization Review
• Medical Documentation
• Claims Management
• Compliance with Industry Standards
• Communication and Interpersonal Skills
• Team Collaboration
• Continuous Improvement

Benefits

• Medical
• Dental
• Vision
• Health Savings Accounts / Flexible Spending Accounts
• Life and AD&D Insurance
• 401(k)
• Tuition Reimbursement
• Resources for Healthy Living

Pay

The expected base pay for this position ranges from $59,500 - $76,000 annually, and will be based on a number of additional factors including skills, experience, and education.

Schedule

This is an In Office Position from Monday - Friday from 9 AM - 5 PM EST.