Utilization Review RN

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RN CASE MANAGEMENT PROFESSIONALS



CLAIM YOUR FUTURE AS A GREAT PERFORMER!



JOIN OUR TEAM!



What drives you in your search for a rewarding career? Are you looking for an opportunity with an industry leader that offers individualized development for talented novices and advanced placements for knowledgeable veterans?



Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. If you are an experienced Registered Nurse looking for personal growth and opportunity to be part of an innovative, customer service oriented disability management team, look no further!



We are proud to have been recently voted the Best TPA in America and the first and only Third Party Administrator to receive the coveted Employer of Choice® designation. Come be a part of our team and "Claim Your Future."


PRIMARY PURPOSE: To provide services for dedicated units; to evaluate need for alternative services and as appropriate, assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's health needs; to promote quality cost-effective outcomes through communication and available resources; and to provide quality, cost effective alternatives to acute care.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

Delivers utilization review services; i.e., administrative continued stay review. Evaluates need for alternative treatment through telephonic contact and assessment with service provider. Negotiates price, level of care, intensity and duration with providers. Documents findings, implements alternative care, continues to evaluate medical necessity of frequency, intensity and length of care with physicians and agency/vendors. Maintains accurate record system of Utilization Review to include cost savings and data collection. Adheres to quality assurance standards. Interacts and coordinates work of Physician Advisors as necessary. May perform review of cases to identify referral for case management. Supports the Total Performance Management initiative.
REQUIREMENTS


Education & Licensing:Baccalaureate degree from an accredited college or university preferred RN licensure required CPUR or equivalent certification preferred

Experience: Minimum Two (2) to Three (3) years of clinical practice experience required



Skills & Knowledge:Strong utilization practice knowledge Knowledge of the insurance industry and claims processing Knowledge of current alternative resources and treatments in out-patient and alternative care settings Excellent oral and written communication skills, 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

Sedgwick CMS is an Equal Opportunity Employer