Utilization Review Nurse (Workers Compensation) - Dallas

Elite

  • Dallas, Texas
  • 30+ days ago

    Highlights

    Review Workers Compensation requests submitted by the provider, requestor, claimant or carrier to determine the medical necessity of the treatment utilizing clinical expertise and evidence-based treatment guidelines. Review requests and make certification decisions, when appropriate, or prepare a case for peer review referral.

    Numbers & Facts

    LocationDallas, Texas

    Description

    Utilization Review Nurse for Workers' Comp

    Job Purpose:
    Review Workers Compensation requests submitted by the provider, requestor, claimant or carrier to determine the medical necessity of the treatment utilizing clinical expertise and evidence-based treatment guidelines.

    Duties:
    • 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 ensure 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.
    Requirements/Skills/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.
    Preferences:
    • Experience in Utilization Review, Workers Compensation is a plus

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