TPA Utilization Nurse

2 weeks ago

Bedford, United States Usi Insurance Services Full time
General Description: Determine the quality of care provided to injured employees for Third Party Administration (TPA) accounts including whether the medical service/procedure is appropriate and effective. Review appropriateness of the health care service to ensure that it is medically necessary and reasonable based on objective, clinical findings. Responsibilities: Review complex workers compensation medical treatment requests to ensure accordance with evidence based medical treatment guidelines, which are generally recognized by the national medical community and are scientifically based. Research claim file in relation to the requested medical treatment while interpreting medical reports/claim summaries and applies appropriate established guidelines to requested treatment. Refer treatment requests which do not meet guidelines for peer review and determination. Advocate for the injured worker and claims department, ensuring proposed treatment requests are appropriate for the diagnosis. Perform daily tasks within the appropriate established workflow processes, utilize accepted guidelines, and meet legislative and departmental timeframes. Maintain patient confidentiality in discussions of treatment/disease process and conditions. Routinely contact providers to clarify treatment requests, examination findings as well as obtain additional medical information as needed. Maintain clear, concise, and accurate documentation of requested medical treatments to include clinical findings, treatment guidelines, and determinations. Act as a medical resource in regard to utilization review to claims support nurse and claims department. Foster a positive and close working relationship with company staff, including claims staff, medical bill review, case manager, legal, and client services. Communicate effectively with individuals outside the company, including clients, medical providers, and vendors. Personal and Organizational Skills: Superior written and oral communication skills. Ability to work well in a team environment. Must have strong analytical thinking and problem-solving skills. Strong organizational skills required. Knowledge, Skills and Abilities: Registered Nurse (RN) from accredited college; bachelor's degree preferred. Must have an active state license and be eligible to obtain additional state licenses. Previously Utilization Review experience required. Minimum 2 years of clinical or related field experience in acute care, emergency medicine, medical surgery, orthopedic practice, or other medical environments where experience could be applied to occupational health. Knowledge of managed care industry practices, including medical case management, utilization review, and related legal, regulatory, and evidence-based medical treatment guidelines. Strong clinical background in orthopedics, neurology, or rehabilitation. Highly organized, with the ability to manage work involving large client volume and adherence to regulatory time frames. Strong understanding of managed care technology applications. Excellent communication skills, both verbal and written. Compensation: 75-85K J-18808-Ljbffr

by Jobble

  • Registered Nurse

    1 month ago

    New Bedford, United States Incredible Health Full time

    Hospitals on Incredible Health are actively hiring and accepting applications in the New Bedford, MA area for the following position: Registered Nurse - ICU. Nurses with experience in any of the following areas are strongly encouraged to apply: Arrhythmia management, Bariatric, CODE, COVID, CRRT training, CVICU, Care of burn patients, Chest tube, ECMO,...

  • Mobile Optometrist

    2 months ago

    New Bedford, United States HealthDrive Corporation Full time

    Overview HealthDrive is currently seeking Optometrists , to work Part Time or Full-time (2-5 days per week) in multiple locations across Eastern Massachusetts (work available in the Greater Boston, South Shore, Southeast MA and Cape Cod areas).  *Opportunity to earn $175,000+ per year at 5 days per week Position offers: Competitive...

  • Nursing Assistant

    1 month ago

    Bedford, Massachusetts, United States VETERANS HEALTH ADMINISTRATION Full time

    Job SummaryThe VETERANS HEALTH ADMINISTRATION is seeking a skilled Nursing Assistant to join our team at the VA Bedford Healthcare System. As a key member of our patient care service, you will play a vital role in delivering high-quality care to our patients.About the RoleThis is a full-time position that involves working a 40-hour week. You will be...

  • Registered Nurse

    2 weeks ago

    Bedford, United States Dartmouth Health Full time

    OverviewThe Clinical Nurse is an engaged and credentialed member of the Professional Nursing Organization and is responsible for autonomous practice directed by the professional tenets of practitioner, leader/decision maker, scientist and transferor. The Clinical Nurse is responsible for utilizing the nursing process to provide evidence-based care and to...

  • Registered Nurse

    1 month ago

    Bedford, United States Dartmouth Health Full time

    Overview The Clinical Nurse is an engaged and credentialed member of the Professional Nursing Organization and is responsible for autonomous practice directed by the professional tenets of practitioner, leader/decision maker, scientist and transferor. The Clinical Nurse is responsible for utilizing the nursing process to provide evidence-based care and to...

  • Clinical Nurse Practitioner

    7 days ago

    Bedford, New Hampshire, United States Dartmouth Health Full time

    About the Role: We are seeking a skilled Clinical Nurse to join our team at Dartmouth Health. As a key member of our nursing organization, you will be responsible for providing evidence-based care and practicing in accordance with the ANA Code of Ethics.Responsibilities:Utilize the nursing process to provide high-quality patient carePractice in accordance...

  • Registered Nurse

    14 hours ago

    Bedford, United States Dartmouth Health Full time

    Overview The Clinical Nurse is an engaged and credentialed member of the Professional Nursing Organization and is responsible for autonomous practice directed by the professional tenets of practitioner, leader/decision maker, scientist and transferor. The Clinical Nurse is responsible for utilizing the nursing process to provide evidence-based care and to...

  • Nursing and Rehabilitation Expert

    4 days ago

    Bedford, Indiana, United States American Senior Communities Full time

    At American Senior Communities, we pride ourselves on delivering exceptional care to our residents. As a Registered Nurse, you will play a pivotal role in enriching the lives of our residents by utilizing your nursing skills to provide top-notch medical attention and fostering a nurturing environment. You will work closely with our interdisciplinary team to...

  • Graduate Nurse Resident Intensive Care Unit

    1 month ago

    Bedford, United States D-H Lebanon-MHMH Full time

    Overview The Clinical Nurse is an engaged and credentialed member of the Professional Nursing Organization and is responsible for autonomous practice directed by the professional tenets of practitioner, leader/decision maker, scientist and transferor. The Clinical Nurse is responsible for utilizing the nursing process to provide evidence-based care and to...

  • Registered Nurse

    3 weeks ago

    Bedford, United States D-H Lebanon-MHMH Full time

    Overview The Clinical Nurse is an engaged and credentialed member of the Professional Nursing Organization and is responsible for autonomous practice directed by the professional tenets of practitioner, leader/decision maker, scientist and transferor. The Clinical Nurse is responsible for utilizing the nursing process to provide evidence-based care and to...

  • Registered Nurse

    1 month ago

    Bedford, United States D-H Lebanon-MHMH Full time

    Overview The Clinical Nurse is an engaged and credentialed member of the Professional Nursing Organization and is responsible for autonomous practice directed by the professional tenets of practitioner, leader/decision maker, scientist and transferor. The Clinical Nurse is responsible for utilizing the nursing process to provide evidence-based care and to...

  • Registered Nurse

    2 months ago

    Bedford, United States Dartmouth Health Full time

    Overview The Clinical Nurse is an engaged and credentialed member of the Professional Nursing Organization and is responsible for autonomous practice directed by the professional tenets of practitioner, leader/decision maker, scientist and transferor. The Clinical Nurse is responsible for utilizing the nursing process to provide evidence-based care and to...

  • Registered Nurse

    3 weeks ago

    Bedford, United States Dartmouth Health Full time

    OverviewThe Cardiology Nurse will be responsible for a mix of phone triage, Nurse visits (Holter and Zio monitor placement, blood pressure checks etc.), IV Insertion for testing, and ACLS is required (can obtain once starting in the dept.).Position can be either Monday-Friday or 4 10's with a TBD day off.Cardiology experience is preferred but would consider...

  • Registered Nurse

    1 month ago

    Bedford, United States American Senior Communities Full time

    Registered Nurse (RN) at Westview Nursing & Rehabilitation 8-hour and 12-hour shifts. Evening and night shift available. Full-time and Part-time available! Why should you be an RN at Westview Nursing & Rehabilitation? As a Registered Nurse, you will have the opportunity to develop meaningful relationships by learning about the life stories of our...

  • Registered Nurse

    3 weeks ago

    Bedford, United States Dartmouth Health Full time

    Overview The Clinical Nurse is an engaged and credentialed member of the Professional Nursing Organization and is responsible for autonomous practice directed by the professional tenets of practitioner, leader/decision maker, scientist and transferor. The Clinical Nurse is responsible for utilizing the nursing process to provide evidence-based care and to...

  • Nursing Professional with Autonomous Practice

    3 weeks ago

    Bedford, New Hampshire, United States D-H Lebanon-MHMH Full time

    Job SummaryWe are seeking a skilled Registered Nurse to join our team at D-H Lebanon-MHMH. As a Clinical Nurse, you will be responsible for delivering high-quality patient care and working collaboratively with the healthcare team to achieve excellent outcomes.About the RoleThis is a per diem/temporary opportunity with a rotating shift schedule. The ideal...

  • Registered Nurse

    4 months ago

    Bedford, United States Westview Nursing & Rehabilitation Center Full time

    Registered Nurse (RN) at Westview Nursing & RehabilitationScroll down to find the complete details of the job offer, including experience required and associated duties and tasks.8-hour and 12-hour shifts. Evening and night shift available. Full-time and Part-time available!Why should you be an RN at Westview Nursing & Rehabilitation?As a Registered Nurse,...

  • Registered Nurse

    2 months ago

    Bedford, United States Westview Nursing & Rehabilitation Center Full time

    Registered Nurse (RN) at Westview Nursing & Rehabilitation8-hour and 12-hour shifts. Evening and night shift available. Full-time and Part-time available!Why should you be an RN at Westview Nursing & Rehabilitation?As a Registered Nurse, you will have the opportunity to develop meaningful relationships by learning about the life stories of our residents and...

  • Licensed Practical Nurse

    4 weeks ago

    Bedford, United States CareerStaff Unlimited Full time

    Licensed Practical Nurse - LPN - Skilled Nursing Facility Invest in your future by discovering a facility in Bedford,PA with resources, technology, and opportunities that will positively impact the rest of your healthcare career. Licensed Practical Nurse's are valued members of the care team that are focused on helping patients with medically complex...

  • CLC Registered Nurse Role

    4 days ago

    Bedford, Massachusetts, United States Veterans Affairs, Veterans Health Administration Full time

    About the Job: We are seeking a skilled and compassionate Registered Nurse to join our Community Living Center (CLC) team at the Veterans Affairs, Veterans Health Administration. In this role, you will have the opportunity to make a meaningful difference in the lives of our veterans by providing high-quality, patient-centered care.Responsibilities: ...