Utilization Review RN

Utilization Review RN

PRIMARY PURPOSE: To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes.

ESSENTIAL RESPONSIBILITIES 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.