LPN Utilization Review Nurse

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

Ability to work any shift between 8:30AM and 8:30PM 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 (preferred)

Work Environment:

This job operates in a professional 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.

Candidates should be comfortable with an on-site presence to support collaboration team leadership and cross-functional partnership.

Why Join Us:

At Acrisure were building more than a business were building a community where people can grow thrive and make an impact. Our benefits are designed to support every dimension of your life from your health and finances to your family and future.

Making a lasting impact on the communities it serves Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Childrens Hospital in Grand Rapids Michigan UPMC Childrens Hospital in Pittsburgh Pennsylvania and Blythedale Childrens Hospital in Valhalla New York.

Employee Benefits

We also offer our employees a comprehensive suite of benefits and perks including:

• Physical Wellness: Comprehensive medical insurance dental insurance and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.

• Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.

• Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.

• Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

• and so much more!

This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.

Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race color religion sex national origin disability or protected veteran status. Applicants may request reasonable accommodation by contacting .

California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.

Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.

Welcome your new opportunity awaits you.