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 Elite Services
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