Utilization Review Nurse

Utilization Review Nurse

Sedgwick | Columbus, OH, 43201, US
Salary Range:$57,000 – $77,000 Salary range estimated by Zippia

Posted 15 days ago

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Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Utilization Review Nurse

**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.

+ Apply your medical/clinical or rehabilitation 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 lives of others, and a remote work environment..

+ Enjoy flexibility and autonomy in your daily work, your location, 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 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.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Identifies treatment plan request(s) and obtains and analyzes medical records that support the request.

+ Clarifies unclear treatment plan requests by contacting the requesting provider's office.

+ Utilizes evidence-based criteria and jurisdictional guidelines to form utilization review determinations.

+ Pursues Physician Advisor services when treatment plan requests do not meet evidenced-based criteria.

+ Negotiates treatment plan requests with requesting provider when medically appropriate and jurisdictionally allowed.

+ Channels certified treatment plan requests to preferred vendors as necessary

+ Documents all utilization review outcomes in utilization review software.

+ Communicates and works with claim examiners as needed to provide clinical information to resolve issues.

+ Maintains a score of 90% or higher on monthly internal utilization review audits.

+ Meets productivity goals as outlined by supervisor.

**Education & Licensing**

Active unrestricted RN license in a state or territory of the United States required. Associate degree from an accredited college or university required. Bachelor's degree from an accredited college or university preferred. Utilization review based certification preferred.

\#nurse #UR #utilizationRN

_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 $55,000 - $78,000 . 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._

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**

**Taking care of people is at the heart of everything we do. Caring counts**

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)