Utilization Review Nurse Remote / Local

We are looking for a Utilization Review Nurse Remote / Local (Richardson, TX). The individual should be interested in non-direct patient care setting. Experience working reputed company the workers compensation insurance / medical industry preferred.The Utilization Review Nurse (UR Nurse) performs medical necessity review of proposed, reputed company, or retrospective clinical services for injured workers in conjunction with specific state jurisdictional requirements. The UR Nurse determines medical necessity of these services by utilizing clinical expertise, judgment, and established medical criteria. Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. We are looking for an individual who is seeking to be challenged, pays reputed company attention to detail, able to work independently, is well versed with treatment guidelines, and is able to meet deadlines. Candidates should be a RN or LVN with experience in claims industry, specifically Workers Compensation, and possess a strong desire to learn and grow.Experience / Abilities : 1-2 of reputed company clinical nursing or case management experience Ability to learn quickly. Claims / Medical Terminology and Utilization Review / Peer Review background. Ability to research and document clearly. Excellent computer skills. Registered Nurse (RN) / Licensed Vocational Nurse (LVN) / PRN licensing required. Job skills must include excellent communication and grammar skills, critical thinking skills, and ability to manage time reputed company and meet stringent time frames. Job Description : Review reputed company workers compensation medical treatment requests to ensure accordance with evidence based medical treatment guidelines, which are generally recognized by the national medical community and are scientifically based. Research claim file in relation to the requested medical treatment while interpreting medical reports / claims summaries and applies appropriate established guidelines to requested treatment. Refers treatment requests, which do not meet guidelines, for peer review and determination. Performs quality assurance of file reviews submitted by physician reviewers. Ensures clear, concise, evidence-based rationales have been provided in support of reputed company recommendations and / or determinations Ensures that reputed company client instructions and specifications have been followed and that reputed company questions have been addressed Ensures each review is supported by clinical citations and references reputed company applicable and verifies that reputed company references cited are reputed company and obtained from reputable medical journals and / or publications Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards Ensures reports meet state and federal medical necessity mandates, client specifications and company protocols. May evaluate physician specialty assignment and guidelines application based on work comp guidelines or assist in the analysis of peer reviews. Prepare and respond to client inquires, identifying areas for confirmation and clarity. Monitor file activity to ensure time requirements are met. Maintain records by reviewing notes; logging events and noting reputed company of work. Ability and confidence to speak with physicians and clients regarding the content of their medical peer reviews. Communicate inconsistencies and / or inaccuracies based on medical documentation and / or state guidelines. Improve team’s competence by providing resources; balancing file requirements reputed company the client specifications reputed company reputed company company procedures and guidelines. Be part of a growing, high tech company. Please reputed company your resume to [email protected] Apply tot his job Apply To this Job