UR Nurse

MedRisk LLC

78d

About The Position

The position involves performing evaluations of medical data for utilization review requests, ensuring that all necessary information is collected to determine medical necessity. The role requires analyzing the collected data in accordance with evidence-based guidelines and providing notifications of decisions to relevant parties upon authorization. Coordination of information between various stakeholders, including injured workers, physicians, employers, therapists, and attorneys, is a key responsibility. Additionally, participation in audits of work products to ensure compliance is expected, along with the completion of all duties as required.

Requirements

• Graduate of an accredited school
• Valid current LVN, LPN, RN, license in good standing
• Possesses and can demonstrate the professional and technical skills of a Registered Nurse, LVN, LPN
• Has professional experience in providing direct patient care and has undergone formal training in a health care field.
• Excellent Written, Oral, and Interpersonal Communication Skills.
• Must be able to maintain confidentiality.
• Strong Organization Skills.
• High comfort level with computers and computer programs (MS Word, MS Excel, Email)
• Ability to work independently with minimal supervision
• Ability to meet deadlines in a fast paced, time sensitive environment
• Experience in Utilization Review, Workers' Compensation experience strongly preferred
• Knowledge of Medical/Clinical Guidelines, such as Milliman, ACOEM, ODG, and /or InterQual

Responsibilities

• Perform an evaluation of the medical data for utilization review requests.
• Collect additional relevant data as needed with regard to determining medical necessity.
• Analyze the collected data to apply evidence-based guidelines.
• Upon authorization, provide notification of decision to provider, requester, claimant, carrier, and all other parties as mandated by law.
• Coordinates information between all parties (injured worker, physicians, employer, therapists, attorney, etc).
• Participate in audits of work product to ensure compliance.
• All Duties as required.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 251-500 employees