Utilization Review Nurse (On-Site) Job at Elite, King of Prussia, PA

VmtvUWpCcjhyMVZNZU85bzF6YVA1VmNRSWc9PQ==
  • Elite
  • King of Prussia, PA

Job Description

Utilization Review Nurse for Workers' Comp
Office Location - Montgomery County Area

Job Purpose:
Review Workers Compensation requests submitted by the provider, requestor, claimant or carrier to determine the medical necessity of the treatment utilizing clinical expertise and evidence-based treatment guidelines.

**Please note that this is an In-office position.

Duties:
  • Perform an evaluation of the medical data for utilization review requests.
  • Confirm accurate completion of data intake.
  • Collect additional relevant data as needed with regard to determining medical necessity.
  • Analyze the collected data to apply evidence-based guidelines.
  • Review requests and make certification decisions, when appropriate, or prepare a case for peer review referral.
  • Coordinates information between all parties (injured worker, physicians, employer, therapists, attorney, etc)
  • Participate in audits of work product to ensure compliance.
  • Monitor daily processing inventory, including rush/urgent requests.
  • Provide inventory information and raise concerns to clinical director.
  • Complete production logging.
  • Assist leadership team with training and coordinating back-up resources.
Requirements/Skills/Qualifications:
  • Graduate of an accredited school
  • Valid current RN license in good standing
  • Able to perform the professional and technical skills of a Registered Nurse
  • Minimum 2 years of direct patient care
  • Excellent, written and oral communication skills
  • Ability to read and interpret medical reports and treatment guidelines
  • Must be able to maintain confidentiality
  • Must possess strong personal organizational skills
  • Must have experience and knowledge of intermediate computer skills
  • Ability to work independently with little to no supervision
  • Ability to work in a fast-paced and time-sensitive environment
  • Ability to meet deadlines in a production driven environment
  • Ability to work with WORD and EXCEL documents.
Preferences:
  • Experience in Utilization Review, Workers Compensation is a plus

Job Tags

Immediate start,

Similar Jobs

TLD Talents Service

外教管理员/Foreign Affairs Specialist Job at TLD Talents Service

1) Foreign Teacher Management: Provide comprehensive management and service support for foreign teachers upon arrival, including visa application, document submission, on-site support, daily life assistance ...

Trident

Real Estate Transaction Coordinator (Remote) - PHILIPPINES ONLY Job at Trident

 ...About Us: Trident is a reputable real estate agency specializing in residential properties...  ...works collaboratively to ensure successful transactions and unparalleled customer satisfaction. Job Responsibilities: Coordinate and manage real estate transaction... 

Woongjin, Inc

Business Analyst - Experience in CRM Job at Woongjin, Inc

 ...Description Overview: We are seeking an experienced Business Analyst to join the Digital Business Division. The successful...  ...audiences Experience with CRM platforms and tools such as Salesforce, Marketo, Eloqua, Adobe Campaign, etc. Knowledge of Gen AI... 

MaKai Consulting, LLC

Pediatric Dental Assistant In Beautiful Napels Job at MaKai Consulting, LLC

 ...Job Posting: Pediatric Dental Assistant Location: Naples, FL Company: Morning Star Children's Dentistry Morning Star Children's Dentistry is a growing pediatric dental practice in Naples, FL, and we are looking for a Dental Assistant who loves working with children... 

Belterra Casino Resort

TABLE GAMES DEALER SCHOOL - NO EXPERIENCE NEEDED! Class will start April 6th and run for 8 weeks. Job at Belterra Casino Resort

 ...established standard policies and procedures. As called upon, explains aspects of various games to gaming patrons. Processes all cash and maintains proper handling and accounting for assigned property items. Maintains familiarity with other gaming and...