Utilization Review Nurse

Sedgwick • Recruiting Only - Telecommuter, TN

2d • $63,000 - $65,000 • Remote

About The Position

This role utilizes evidence-based tools to evaluate prescribed treatment, ensuring patient safety and quality standards align with best practice. The ideal candidate will apply RN clinical knowledge and experience to assist in managing complex medical conditions, treatment planning, and recovery from illness or injury. This is a remote position offering flexibility and autonomy, where the nurse advocates for effective and efficient medical treatment for injured employees in a non-traditional setting. The role supports Sedgwick's mission of assisting injured employees and is part of a rapidly growing, industry-leading global company.

Requirements

• Active unrestricted RN license in a state or territory of the United States required.
• Two (2) years of direct clinical experience as an RN is required.
• Computer keyboarding
• Hearing, vision and talking
• Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

Nice To Haves

• Compact licensure preferred.
• 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.

Benefits

• medical, dental vision, 401K, PTO and more beginning your first day.
• medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level