Utilization Management Specialist

ReviewWorks, founded in 1989, is a nationwide, full service provider of medical cost containment services for the workers compensation and auto no-fault/liability markets. Our cost management services include hospital and provider bill review featuring our web-based image repository. ReviewWorks is a Women's Business Enterprise National Council (WBENC) certified business. Please visit our website at http://www.reviewworks.com/.

We are currently looking for a Registered Nurse to join our growing Utilization Management department. This Utilization Management Specialist position is responsible for evaluating and forwarding all medical records for relatedness to covered injury, appropriateness of treatment, and length of treatment to a physician of same medical expertise as the treating provider.

Essential Functions:

• Prepare and organize medical files and records. Request additional records as needed.
• Make determination for a Physician Review. 
• Based on the Physician Advisors recommendations provide a professional review of all attached medical bills. Complete all required documentation.
• Communicate with carriers, providers and claimants in all aspects of the Utilization Review process. 
• Communicate and assist all internal team members to expedite the professional review process.

Qualifications Required:

• Registered Nurse currently licensed in Michigan
• At least 3 years clinical experience in the following areas: ER, OR, Orthopedics, Neurology and/or ICU/CCU.
• Minimum of one year of utilization review experience. 
• Strong working knowledge of Auto No-fault and Workers Compensation medical bill review.
• Computer PC skills - proficient at Microsoft Word and Excel.

Qualifications Preferred: 

• ABQAURP or CPUR Certification.

We are an equal employment opportunity employer. We offer medical, dental, Life, STD and LTD benefits, 401K, and Paid Time Off (PTO).