Utilization Review Nurse - Dallas, TX

Injury Management Organization, Inc•Plano, TX

1d•$72,000 - $76,000•Hybrid

About The Position

Join our dedicated team at Injury Management Organization, Inc. as a Full-Time Registered Nurse specializing in Utilization Review! Located in Plano, TX, this hybrid position offers an exciting opportunity for RNs with a background in Workers' Compensation to apply their critical thinking skills and independent judgment in evaluating patient care. You'll leverage your expertise in medical terminology and familiarity with CPT/ICD-10 codes to ensure optimal outcomes for our clients while working in a flexible and customer-focused environment. With a competitive salary range of $72,000 to $76,000, this role rewards your dedication and passion for excellence in healthcare. Your contributions will play a vital role in fostering teamwork and stewardship in our organization, where engagement and accountability are paramount. As a Utilization Review Registered Nurse at Injury Management Organization, Inc., you will play a crucial role in evaluating medical treatment records for patients with work-related injuries. Your primary responsibility will be to make informed clinical determinations in alignment with ODG criteria, utilizing evidence-based guidelines to establish the medical necessity of services requiring preauthorization. You will process requests from healthcare providers and injured employees, ensuring compliance with Texas Department of Insurance Rule 134.600 and 137.100. This vital function allows you to employ your skills in medical terminology and critical thinking while maintaining a focus on exceptional patient care, all within a supportive and innovative team environment.

Requirements

Must have and maintain a valid RN license in accordance with the Texas Board of Nursing
At least 3 years' experience working in the area of Workers' Compensation which may include Case Management, Orthopedic nursing, and/or Utilization Review experience
Maintain current knowledge and requirements as related to Texas Workers' Compensation rules
Knowledge of CPT/ICD-10 codes and medical terminology
Requires excellent computer/technology skills
Exceptional interpersonal and communication skills
Familiarity with standard evidence-based practice guidelines and best treatment practices
Strong critical thinking skills and independent judgment

Nice To Haves

Bilingual English/Spanish

Responsibilities

Apply critical thinking skills and independent judgment in evaluating patient care
Leverage expertise in medical terminology and familiarity with CPT/ICD-10 codes to ensure optimal outcomes for clients
Evaluate medical treatment records for patients with work-related injuries
Make informed clinical determinations in alignment with ODG criteria, utilizing evidence-based guidelines to establish the medical necessity of services requiring preauthorization
Process requests from healthcare providers and injured employees
Ensure compliance with Texas Department of Insurance Rule 134.600 and 137.100
Coordinate reviews with physicians across various specialties
Assess the medical necessity of services for injured employees
Compile, process, and maintain medical records meticulously
Adhere to the ethical, legal, and regulatory requirements of the healthcare system
Utilize relevant software and tools for streamlining the review process and ensuring accurate documentation
Make sound clinical determinations that align with both organizational goals and patient care standards