RN Utilization Review

• Apply your RN clinical knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury.

• Work in the best of both worlds - a rewarding career making an impact on the health and well-being of others in a remote work environment.

• Enjoy flexibility and autonomy in your daily work and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. 

• Enable our Caring Counts® mission of supporting injured employees from some of the world’s best brands and organizations. 

• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. 

• Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. 

• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. 

PRIMARY PURPOSE: To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes.

ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE:

• Performs clinical assessments via information in medical files; assesses injured employee’s situation which may include psychosocial needs.

• Evaluates patient condition including treatment utilization and compliance. Evaluates need for and recommends alternative treatment.

• Collaborate effectively with physicians, claims examiners, clients, vendors, supervisors and other parties as needed.

• Negotiates appropriate level and intensity of care through use of medical and disability guidelines, adhering to quality assurance standards.

• Acts as a resource in consulting with the client, nursing staff and claims examiners regarding treatment issues.

• Performs treatment utilization management reviews.

• Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.

EDUCATION AND LICENSING:

• Active unrestricted RN license in a state or territory of the United States required. Compact licensure preferred. Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred. Two (2) years of direct clinical experience as an RN is required..

TAKING CARE OF YOU :

• Seeks innovative customer solutions.

• Craves cutting edge opportunities. 

• Wants dynamic company culture.

• Passion about creativity. 

• Seeks ongoing learning as a person and professional.

• Thrives when solving challenging problems.

• Wants achievements to be celebrated. 

• We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.

NEXT STEPS

If your application is selected to advance to the next round, a recruiter will be in touch.

#nurse

Work environment requirements may include –
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $63,000-$65,000/year.  A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.