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Utilization Review Specialist
6 days agoWhat's your preference?
Job Description
- Req#: cdbe5519-bea9-41a4-b99f-a31716644a04
Employer Industry: Insurance and Medical Management
Why consider this job opportunity:
- Salary up to $75,000 per year
- Comprehensive benefits package including medical, dental, and vision plans
- 401k plan with employer matching for a secure financial future
- Flexible time-off policies promoting a healthy work-life balance
- Opportunity to work in a diverse and inclusive environment that values innovation
- Chance to play a critical role in ensuring quality care for injured workers
What to Expect (Job Responsibilities):
- Conduct precertification, concurrent, retrospective, and appeal reviews in compliance with URAC guidelines
- Coordinate peer reviews and facilitate telephonic reviews with peer review physicians
- Document all medical, clinical, and contact information accurately in the case management system
- Draft and revise determination letters and correspondence in line with established protocols
- Serve as a patient advocate while ensuring compliance with legal and ethical standards
What is Required (Qualifications):
- Registered Nurse (RN) or Licensed Practical Nurse (LPN) with a minimum of three (3) years of clinical experience
- Minimum of two (2) years of Utilization Review experience in Workers' Compensation, Health & Accident, or Auto Liability
- Proof of current, unrestricted state RN or LPN licensure or multi-state compact licensure
- Strong knowledge of Workers' Compensation laws and managed care arrangements
- Excellent written and verbal communication skills
How to Stand Out (Preferred Qualifications):
- Experience in varied hospital specialty units, including ER, ICU/CCU, Surgery, Trauma, Orthopedics, Neurology, and/or Psychiatry
- Ability to work independently in a fast-paced environment
- Proficiency with utilization review systems and standard business software
- Strong organizational and time-management skills
- Commitment to maintaining current knowledge of industry trends and regulations
#InsuranceManagement #UtilizationReview #HealthcareCareers #DiversityAndInclusion #CareerGrowth
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