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Advance your career at Company Insurance - A Fortune 100 Company!
If you're a registered nurse looking for a new opportunity to work in a fast-paced, professional environment where your talent contributes to our competitive edge, Company Insurance has the opportunity for you. The Utilization Management Nurse performs review services to determine if medical treatment and/or hospitalization are necessary and is delivered in the most appropriate treatment setting. The role negotiates with healthcare providers when medical requests exceed criteria and standards, where allowed by law, and identifies potential alternatives to promote cost effective clinical outcomes. This position provides technical direction on complex treatment requests, appeals, etc.
Conduct recertification, and extensions of utilization review services which may include determinations for inpatient and outpatient admissions, physical, occupational, or chiropractic therapy treatments, diagnostic testing, etc., using nationally recognized criteria and personal clinical experience and medical knowledge.
Initiate referrals to Peer Review Services appropriately, and coordinate the services to support the utilization review. Ensure that peer review decisions are communicated within 1-2 business days.
Perform Utilization Management services within established clinical, productivity, phone and URAC standards. This includes ensuring that an Utilization Management determination is communicated to the provider within two business days of receipt of the medical information or as determined by Worker's Compensation law.
3+ Years of relevant nursing experience
Degree from an accredited nursing school required, Bachelor of Science in Nursing preferred.
Current nursing registration required.
Basic knowledge of states workers' compensation laws, disability management and utilization product review preferred.
Strong communication and interpersonal skills in order to receive and/or exchange information with healthcare providers, vendors, customers/injured workers, regulatory agencies, and legal professionals.
Good negotiation skills to effectively establish target return to work dates.
This position is open to candidates located within commuting distance of our Tampa FL, Wausau WI, and Syracuse NY offices. Candidates unable to commute to one of these offices daily or those seeking 100% work from home will not be considered.
We value your hard work, integrity and commitment to positive change. In return for your service, it’s our privilege to offer you benefits and rewards that support your life and well-being. To learn more about our benefit offerings please visit: Company website
At Company, we give motivated, accomplished professionals the opportunity to help us redefine what insurance means; to work for a global leader with a deep sense of humanity and a focus on improving and protecting everyday lives. We create an inspired, collaborative environment, where people can take ownership of their work; push breakthrough ideas; and feel confident that their contributions will be valued and their growth championed.
We’re dedicated to doing the right thing for our employees, because we know that their fulfillment and success leads us to great places. Life. Happiness. Innovation. Impact. Advancement. Whatever their pursuit, talented people find their path at Company.
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