RN Utilization Review
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 the health and well-being of others in a remote work environment.
- Enjoy flexibility and autonomy in your daily work and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting.
- Enable our Caring Counts® mission of supporting injured employees from some of the world’s best brands and organizations.
- Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
- Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more.
- Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
PRIMARY PURPOSE: To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes.
ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
- 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..
Work environment requirements may include – Physical: Computer keyboarding Auditory/visual: Hearing, vision and talking Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines
For the jurisdiction noted in this job posting only, the range of starting pay for this role is $63,000-$65,000/year.