Utilization Review Nurse
Utilization Review Nurse
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1 Vacancy
Job Description
Job Title: Utilization Review Nurse LPN or RN
Position Type : Full time
Reports To: Manager Utilization Review & Specialty Products
Job Purpose: Ensuring all projects follow Case Management Standards of Practice
Promotes and restores individuals health and wellbeing by completing a collaborative process of assessment planning facilitation care coordination evaluation and advocacy for options and services to meet an individuals comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. CMSA Standards of Practice
Essential Functions
Review treatment requests from medical professionals for adherence to state mandated guidelines
Make determinations on which referrals can be authorized at the nurse level and which will be sent for physician review
Perform all necessary paperwork and billing from open to close of the UR review within state mandated and/or URAC turnaround time requirements
At full-time status the UR nurse will process a minimum of 12 reviews daily
Document medical treatment requests and associated medical information in client records.
Maintains client confidence and ethical and HIPAA standards by keeping information confidential.
Maintains professional and industry knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies
Maintains a cooperative relationship among health care teams by communicating information; responding to requests; building rapport; participating in team problem-solving methods.
Contributes to the Ascential Care Partners team effort by reflecting company philosophy and demonstrating ardent customer service-related results.
Other duties as assigned from time to time.
Skills / Qualifications:
Clear active LPN license or RN License
Ability to work any shift between 8:30AM and 8:30PM EST
CA UR Nurse is required to work 11:30a-8p EST
Strong organizational task prioritization and delegation skills
Ability to maintain accurate records prepare reports correct English usage and maintain confidentiality
Computer literacy on Microsoft Office products and ability to learn new software
Ability to construct grammatically correct reports using standard medical terminology
Ability to use a computer keyboard and mouse 7-8 hours per day
Dedicated work area allowing for maintaining confidentiality of records access to high-speed internet and strong cellular phone service
Preferred:
A minimum of 2 years experience in workers compensation utilization review
Compact state license
Work Environment
This job operates in a professional or work-from-home office environment. This role routinely utilizes standard office equipment such as computers phones printers filing cabinets and fax machines.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job the employee is regularly required to communicate with and listen to internal and external clients. The employee is required to sit frequently frequently use the keyboard and mouse occasionally stand; walk; and reach with hands and arms.
Other Duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this job. Duties responsibilities and activities may change at any time with or without notice.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Acrisure is committed to employing a diverse workforce. All applicants will be considered foremploymentwithout attention to race color religion age sex sexual orientation gender identity national origin veteran or disability status. California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisures property and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisures Human Resources Talent Department.
Employment Type
Full-Time
