Utilization Review Nurse /Workers Comp
Location - King of Prussia, PA

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.

Qualifications

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 Type: Full-time

Pay: $68,000.00 - $80,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

License/Certification:

• current RN License in good standing? (Preferred)

Ability to Commute:

• King of Prussia, PA (Required)

Ability to Relocate:

• King of Prussia, PA: Relocate before starting work (Required)

Work Location: In person