Utilization Review Nurse

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Dane Street

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

Dane Street is a national leader in Independent Medical Exams and Reviews, providing objective, compliant, and timely Independent Medical Examinations, Peer Reviews, and other medical reports. With a large network of over 16,000 physicians, the company offers its services across 25,000 locations and 100 specialties, including Workers' Compensation, Auto, Liability, and Disability claims. Dane Street supports Insurance Carriers, Third Party Administrators, Managed Care Organizations, and Federal/State entities with expert medical analyses, helping them make accurate determinations. The company is recognized for its quality, fast turnaround times, and efficient processes, earning accolades like the NCQA Accreditation in Utilization Management and the Great Place to Work certification.

📋 Description

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria). • Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services. • Offer clinical expertise and serve as a clinical reference for non-clinical staff members. • Input and manage essential clinical details within various medical management platforms. • Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review. • Apply clinical reasoning to determine the suitable evidence-based guidelines. • Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

🎯 Requirements

• Proficient in both written and spoken communication. • Capable of maintaining professional communication with physicians and clients. • Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting. • Possesses a keen organizational sense and pays close attention to details. • Adept at resolving intricate and multifaceted problems. • Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook. • Background in medical or clinical practice through education, training, or professional engagement. • Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

🏖️ Benefits

• medical, dental, and vision coverage for you and your family. • voluntary life insurance options for you, your spouse, and your children. • other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. • basic life insurance, short-term disability, and long-term disability coverage at no cost. • generous paid time off policy ensures you have time to relax and recharge. • 401k plan with a company match helps you plan for your future. • Apple equipment and a media stipend are provided for remote workspace.