Utilization Review Nurse

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $73k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• Identify treatment plan requests and obtain and analyze supporting medical records • Clarify unclear treatment plan requests by contacting requesting provider offices • Use evidence-based criteria and jurisdictional guidelines to make utilization review determinations • Pursue Physician Advisor services when requests do not meet evidence-based criteria • Negotiate treatment plan requests with requesting providers when medically appropriate and jurisdictionally allowed • Channel certified treatment plan requests to preferred vendors as necessary • Document utilization review outcomes in utilization review software • Communicate and work with claim examiners to provide clinical information and resolve issues • Maintain a monthly internal utilization review audit score of 90% or higher • Meet productivity goals outlined by the supervisor

🎯 Requirements

• Active unrestricted RN license in a state or territory of the United States required • Associate degree from an accredited college or university required • Utilization review based certification preferred • Four (4) years of related experience or equivalent combination of education and experience required • Two (2) years of recent clinical practice or one (1) year of recent utilization review • Clear and conceptual thinking ability • Excellent judgment, troubleshooting, problem solving, analysis, and discretion • Ability to handle work-related stress • Ability to handle multiple priorities simultaneously • Ability to meet deadlines • Computer keyboarding ability • Hearing, vision, and talking abilities

🏖️ Benefits

• Blended work environment • On-going learning and professional growth opportunities • Diverse and comprehensive benefits package • Three medical plans to choose from • Two dental plans to choose from • Tuition reimbursement eligibility • 401K plan matching 50% of contributions up to the first 6% saved • 4 weeks PTO during the first full year • Vision insurance • Disability insurance • Life insurance • Employee assistance program • Flexible spending or health savings account • Additional voluntary benefits