Utilization Reviewer

Mitchell International

282d • $52,719 - $76,000 • Remote

About The Position

We are seeking a qualified Utilization Reviewer who can work remotely from home. The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in assessing and ensuring the appropriateness of medical treatment plans, contributing to effective claims management and optimal patient outcomes.

Requirements

• Minimum Education: Associates degree.
• Must have active Registered Nurse (RN) license in the state of PA.
• Minimum of 2 years of clinical experience; or an advanced degree without experience.
• Knowledge of medical terminology, treatment modalities, and healthcare guidelines.
• Analytical and critical thinking skills for effective decision-making.
• Strong communication and interpersonal skills to liaise with diverse stakeholders.
• Ability to work independently and collaboratively within a team environment.
• Detail-oriented with strong organizational skills to manage multiple cases efficiently.
• Familiarity with relevant software and tools used in healthcare.

Nice To Haves

• Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity.
• Prior experience in the workers' compensations field.

Responsibilities

• Uses solid clinical judgment to ensure treatment approved is medically necessary.
• Forwards treatment requests for physician reviewer that cannot be approved as medically necessary based on application of solid clinical judgment.
• Collaborates with healthcare providers, claims adjusters, and other stakeholders to gather relevant information for comprehensive assessments.
• Evaluates medical documentation to ensure compliance with industry standards and regulatory requirements.
• Communicates findings clearly and concisely through written reports and verbal discussions.
• Stays up-to-date on industry regulations, medical advancements, and best practices to enhance the quality of reviews.
• Participates in team meetings and contributes to the continuous improvement of utilization review processes.

Benefits

• Medical, Dental, Vision
• Health Savings Accounts / Flexible Spending Accounts
• Life and AD&D Insurance
• 401(k)
• Tuition Reimbursement
• An array of resources that encourage a lifetime of healthier living.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Publishing Industries
• Education Level: Associate degree