RN Utilization Review job opportunity at Sedgwick.

Home Jobs In United States Of America Tag: Job RN Utilization Review position at Sedgwick


DatePosted 2 Days Ago bot
Sedgwick RN Utilization Review
Experience: General
Pattern: full-time
Country:
apply Apply Now
Salary:
Status:

Job

Copy Link Report
degreeAssociate
loacation Telecommuter MI, United States Of America
loacation Telecommuter M..........United States Of America

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review PRIMARY PURPOSE : To provide timely, evidence-based utilization review services to maximize quality care and  cost-effective outcomes. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Identifies treatment plan request(s) and obtains and analyzes medical records that support the reque Clarifies unclear treatment plan requests by contacting the requesting provider's office. Utilizes evidence-based criteria and jurisdictional guidelines to form utilization review determinations. Pursues Physician Advisor services when treatment plan requests do not meet evidenced-based criteria. Negotiates treatment plan requests with requesting provider when medically appropriate and jurisdictionally allowed. Channels certified treatment plan requests to preferred vendors as necessary Documents all utilization review outcomes in utilization review software. Communicates and works with claim examiners as needed to provide clinical information to resolve issues. Maintains a score of 95% or higher on internal utilization review audits. Meets productivity goals as outlined by supervisor. Performs other duties as assigned. Supports the organization's quality program(s Strong clinical practice knowledge Ability to meet or exceed Performance Competencies Ability to work in a team environment Excellent negotiation skills Excellent interpersonal skills Strong organizational skills Analytical and interpretive skills PC literate, including Microsoft Office products Excellent oral and written communication, including presentation skills Knowledge of the insurance industry and claims processing WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations.   Mental: 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; and ability to meet deadlines   Physical: Computer keyboarding, travel as required   Auditory/Visual: Hearing, vision and talking   The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. ​ QUALIFICATIONS Education & Licensing Bachelor's or Associate degree from an accredited college or university preferred. Current unrestricted RN license in a state or territory of the United States required. Utilization review based certification strongly preferred. Must obtain Texas and Tennessee RN licenses within 3 months . Experience Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years of recent clinical practice OR one (1) year of recent utilization review. Skills & Knowledge Strong clinical practice knowledge Knowledge of the insurance industry and claims processing Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Excellent interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental:  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; and ability to meet deadlines Physical:  Computer keyboarding, travel as required Auditory/Visual:  Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Other Ai Matches

Workforce Absence Team Lead Applicants are expected to have a solid experience in handling Job related tasks
Claims Examiner | General Liability BI | Captive | Remote Applicants are expected to have a solid experience in handling Job related tasks
Physical Therapy Case Manager Applicants are expected to have a solid experience in handling Job related tasks
Receptionist | In-office (Orange, CA) Applicants are expected to have a solid experience in handling CA) related tasks
MCL Operations Director & Executive MCL Adjuster Applicants are expected to have a solid experience in handling Job related tasks
Senior projectleider bodemsanering Applicants are expected to have a solid experience in handling Job related tasks
National General Adjuster - Northeast Region Applicants are expected to have a solid experience in handling Job related tasks
National General Adjuster - Southwest Region Applicants are expected to have a solid experience in handling Job related tasks
Staff Field Auto Appraiser: Open to Atlanta, Philadelphia, Buffalo Applicants are expected to have a solid experience in handling Philadelphia, Buffalo related tasks
Desk Adjuster Applicants are expected to have a solid experience in handling Job related tasks
Workers Compensation Claims Examiner | Dedicated Client | NY Licensing Required | Remote Applicants are expected to have a solid experience in handling Job related tasks
Workers Compensation Claims Examiner (Dedicated Client)| Rancho Cordova, CA | Hybrid Applicants are expected to have a solid experience in handling CA | Hybrid related tasks
Disability Representative Sr Applicants are expected to have a solid experience in handling Job related tasks
Claims Examiner - Workers Compensation - California Applicants are expected to have a solid experience in handling Job related tasks
Claims Examiner - Liability | GL & BI | Jurisdiction: South East and Eastern States | Licensing: TX/FL (Hybrid) Applicants are expected to have a solid experience in handling Job related tasks
ADA Accommodation Specialist Applicants are expected to have a solid experience in handling Job related tasks
Claims Team Lead - General Liability | Public Entity Exp. Required Applicants are expected to have a solid experience in handling Job related tasks
Property Adjuster- Condo Experience Required Applicants are expected to have a solid experience in handling Job related tasks
Care Team Representative Applicants are expected to have a solid experience in handling Job related tasks
Loss Adjusters (Melaka) Applicants are expected to have a solid experience in handling Job related tasks
Claims Manager - KFZ-Schadenbearbeitung (w/m/d) - Hybrid / Remote Applicants are expected to have a solid experience in handling Job related tasks
Executive Adjuster - Major Complex Loss Applicants are expected to have a solid experience in handling Job related tasks
Workers Compensation - Claims Standards & Compliance Analyst | Ontario, California Applicants are expected to have a solid experience in handling California related tasks