Registered Nurse (RN) - Utilization Review
MedRisk
King Of Prussia, PA

UR Nurse

Who We Are We're a group of talented, driven professionals who strive every day to improve the lives of our clients, our providers and the ultimate stakeholders - the injured workers. We offer an exciting workplace environment plus competitive salaries and benefits. What makes us stand out? It's the people, the culture we foster and the opportunity to learn and to grow. Job Summary A UR Nurse, also known as a Utilization Review Nurse, is responsible for reviewing and evaluating the medical necessity and appropriateness of healthcare services provided to patients. They work closely with healthcare providers, insurance companies, and patients to ensure that the services being provided align with established guidelines and policies. UR Nurses also play a vital role in managing healthcare costs and optimizing the utilization of resources while maintaining quality care for patients. Primary Duties & Responsibilities * Perform an evaluation of the medical data for utilization review requests. * Confirm accurate completion of data intake. * Collect additional relevant data as needed with regard to determining medical necessity. * Analyze the collected data to apply evidence-based guidelines. * Review requests and make certification decisions, when appropriate, or prepare a case for peer review referral. * Coordinates information between all parties (injured worker, physicians, employer, therapists, attorney, etc) * Participate in audits of work product to insure compliance. * Monitor daily processing inventory, including rush/urgent requests. * Provide inventory information and raise concerns to clinical director. * Complete production logging. * Assist leadership team with training and coordinating back-up resources. Qualifications * Graduate of an accredited school * Valid current RN license in good standing * Able to perform the professional and technical skills of a Registered Nurse * Minimum 2 years of direct patient care * Excellent, written and oral communication skills * Ability to read and interpret medical reports and treatment guidelines * Must be able to maintain confidentiality * Must possess strong personal organizational skills * Must have experience and knowledge of intermediate computer skills * Ability to work independently with little to no supervision * Ability to work in a fast-paced and time-sensitive environment * Ability to meet deadlines in a production driven environment * Ability to work with WORD and EXCEL documents. * This is a PA Hybrid Position. * Experience in Utilization Review, Workers Compensation is a plus Working Conditions & Physical Requirements * Office & Home environment * While mostly sedentary, the job includes walking, standing, sitting, possible twisting, kneeling * Visual acuity (color, depth perception and field of vision) * Substantial movements (motions) of the arms, wrists, hands, and/or fingers * This position requires consistent communication both verbally and electronically. Candidate must be able to utilize exceptional verbal and written communication skills. What We Offer * Remote and Hybrid work opportunities * Great work-life balance: Monday-Friday work schedule * Medical, Dental and Vision insurance * Company paid Life & Disability Insurance * Flexible Spending Accounts * 401(k) matching * Generous paid time off policies: Holidays, PTO, plus 2 floating holidays * Employee Assistance Programs * Referral Programs Disclaimer The aforementioned statements are intended to describe the general nature and level of work to be performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of an incumbent.