RN Utilization Review

Sedgwick

19h•Remote

About The Position

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 OF THE ROLE: To utilize evidence-based tools to evaluate the prescribed treatment to ensure patient safety and quality standards are in alignment with best practice standards. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. Apply your RN clinical knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. Work in the best of both worlds - a rewarding career making an impact on the health and well-being of others in a remote work environment. Enjoy flexibility and autonomy in your daily work and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. Enable our Caring Counts® mission of supporting injured employees from some of the world’s best brands and organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Requirements

Active unrestricted RN license in a state or territory of the United States required.
Compact licensure preferred.
Two (2) years of direct clinical experience as an RN is required.

Nice To Haves

Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred.
Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.

Responsibilities

Performs clinical assessments via information in medical files; assesses injured employee’s situation which may include psychosocial needs.
Evaluates patient condition including treatment utilization and compliance.
Evaluates need for and recommends alternative treatment.
Collaborate effectively with physicians, claims examiners, clients, vendors, supervisors and other parties as needed.
Negotiates appropriate level and intensity of care through use of medical and disability guidelines, adhering to quality assurance standards.
Acts as a resource in consulting with the client, nursing staff and claims examiners regarding treatment issues.
Performs treatment utilization management reviews.
Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.