RN Utilization Review
Company: Sedgwick
Location: Jackson
Posted on: June 25, 2022
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Job Description:
**The 'Apply with SEEK' option will be utilized for
International applicants, mainly Australia. If this does not apply
to you please use the 'Apply' option.**RN Utilization ReviewIF YOU
CARE, THERE'S A PLACE FOR YOU HEREFor a career path that is both
challenging and rewarding, join Sedgwick's talented team of 27,000
colleagues around the globe. Sedgwick is a leading provider of
technology-enabled risk, benefits and integrated business
solutions. Taking care of people is at the heart of everything we
do. Millions of people and organizations count on Sedgwick each
year to take care of their needs when they face a major life event
or something unexpected happens. Whether they have a workplace
injury, suffer property or financial loss or damage from a natural
or manmade disaster, are involved in an auto or other type of
accident, or need time away from work for the birth of a child or
another medical situation, we are here to provide compassionate
care and expert guidance. Our clients depend on our talented
colleagues to take care of their most valuable assets-their
employees, their customers and their property. At Sedgwick, caring
counts -. Join our team of creative and caring people of all
backgrounds, and help us make a difference in the lives of
others.**PRIMARY PURPOSE** : To provide timely, evidence-based
utilization review services to maximize quality care and
cost-effective outcomes.**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.**ADDITIONAL
FUNCTIONS and RESPONSIBILITIES**+ Performs other duties as
assigned.+ Supports the organization's quality
program(s)**QUALIFICATIONS****Education & Licensing**Active
unrestricted RN license in a state or territory of the United
States required. Bachelor's or Associate degree from an accredited
college or university preferred. Utilization review based
certification strongly preferred.**Experience**Four (4) years of
related experience or equivalent combination of education and
experience required to include two (2) years of recent clinical
practice **OR** one (1) year of recent utilization review.**Skills
& Knowledge**+ Strong clinical practice knowledge+ Knowledge of the
insurance industry and claims processing+ Excellent oral and
written communication, including presentation skills+ PC literate,
including Microsoft Office products+ Analytical and interpretive
skills+ Strong organizational skills+ Excellent interpersonal
skills+ Excellent negotiation skills+ Ability to work in a team
environment+ Ability to meet or exceed Performance
Competencies**WORK ENVIRONMENT**When applicable and appropriate,
consideration will be given to reasonable
accommodations.**Mental:** Clear and conceptual thinking ability;
excellent judgment, troubleshooting, problem solving, analysis, and
discretion; ability to handle work-related stress; ability to
handle multiple priorities simultaneously; and ability to meet
deadlines**Physical:** Computer keyboarding, travel as
required**Auditory/Visual:** Hearing, vision and talkingAs required
by law, Sedgwick provides a reasonable range of compensation for
roles that may be hired in (Colorado or New York City). 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 state noted in this job posting only, the range
of starting pay for this role is $54,838 - $76,875. 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.Sedgwick is an Equal Opportunity Employer
and a Drug-Free Workplace.
Keywords: Sedgwick, Jackson , RN Utilization Review, Healthcare , Jackson, Mississippi
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