UR Nurse

Responsibilities

Perform an evaluation of the medical data for utilization review requests.

Collect additional relevant data as needed with regard to determining medical necessity.

Analyze the collected data to apply evidence-based guidelines.

Upon authorization, provide notification of decision to provider, requester, claimant, carrier, and all other parties as mandated by law.

Coordinates information between all parties (injured worker, physicians, employer, therapists, attorney, etc)

Participate in audits of work product to ensure compliance.

All Duties as required.

Requirements/Skills/Qualifications:
Graduate of an accredited school

Valid current LVN, LPN, RN, license in good standing

Possesses and can demonstrate the professional and technical skills of a Registered Nurse, LVN, LPN,

Has professional experience in providing direct patient care and has undergone formal training in a health care field.

Excellent Written, Oral, and Interpersonal Communication Skills.

Must be able to maintain confidentiality.

Strong Organization Skills.

High comfort level with computers and computer programs (MS Word, MS Excel, Email)

Ability to work independently with minimal supervision

Ability to meet deadlines in a fast paced, time sensitive environment

Experience in Utilization Review, Workers' Compensation experience strongly preferred

Knowledge of Medical/Clinical Guidelines, such as Milliman, ACOEM, ODG, and /or InterQual