TPA Utilization Nurse

3 weeks ago

Needham Heights, United States USI Insurance Services Full time

Job Description: General Description: Determine the quality of care provided to injured employees for Third Party Administration (TPA) accounts including whether the medial service/procedure is appropriate and effective. Review appropriateness of the health care service to ensure that 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 meets 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; bachelors' degree preferred. Must have an active state license and is 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 environment 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 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.Comp: 75-85KWhy USI?With more than $2.7 billion in revenue and over 10,000 associates across approximately 200 offices nationwide, USI is one of the largest insurance brokerage and consulting firms in the world. At USI, we have created one of the most dynamic personal and professional development cultures in the industry. We invest heavily in our associates, and we take pride in celebrating their growth and success through our one-of-a-kind employee reward and recognition programs.Unrivaled Resources and SupportWhat truly distinguishes USI as a premier insurance brokerage and consulting firm is the USI ONE Advantage® , a game-changing value proposition that delivers to clients a robust set of risk management and benefit solutions with bottom-line financial impact. USI ONE® represents Omni, Network, Enterprise—the three key elements that set USI apart from the competition. Through USI ONE, we develop strategic, timely, and effective risk management and benefit programs in terms that are easy to understand, and we demonstrate how the solutions can have a positive economic impact.Industry-Leading Programs, Rewards, and Recognition In addition to competitive pay, incentives, and benefits, USI recognizes associates through our Summit Awards program, rewarding excellence in those who build our brand each day. USI offers employee programs that recognize outstanding achievement and help our associates lead healthy, productive lives. We turn care into action with our award-winning wellness program, college scholarships for associates' children, and financial help in times of need.Deep Community EngagementWe are committed to giving back to our local communities and supporting a culture of environmental sustainability. From sharing our time, talent, and resources to support local non-profit organizations, animal shelters, and environmental beautification and restoration projects – to partnering with eco-conscious vendors and taking steps to reduce our own environmental footprint – we’re working together as ONE to build a better future.Committed to a Diverse, Equitable, and Inclusive WorkplaceOur award-winning I’m With U diversity, equity, and inclusion program educates our associates to help them better understand and serve our clients, prospects, fellow team members, and local communities through curated education and training resources, employee support programs, and community outreach initiatives to build a more diverse, equitable, and inclusive culture.Nationally Recognized as a Top Insurance Employer Recognized as one of Insurance Business America’s Top Insurance Employers for the seventh consecutive year (2018-2024). Named to Business Insurance’s annual list of the Best Places to Work in Insurance five years in a row (2020-2024). Named to Fortune’s 2024 Best Workplaces in Financial Services & Insurance list. Honored by Glassdoor as a Best-Led Company in the U.S. in 2024. Recognized by Newsweek as one of America’s Greatest Workplaces for Diversity in 2024 Visit our Awards and Accolades page for a complete list of our latest industry awards and recognitionsUSI is committed to providing a full-suite of competitive benefits for our growing population and its diverse needs. We offer a wide range of health, welfare and financial benefits including medical, wellness, dental and vision, 401(k), flexible spending and health savings accounts, short and long-term disability, life insurance and other unique employer-sponsored and voluntary programs. USI also offers a generous paid time off policy, paid family leave benefit as well as paid holiday time .

  • Registered Nurse

    2 months ago

    Needham, United States Incredible Health Full time

    Hospitals on Incredible Health are actively hiring and accepting applications in the Needham, 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, External...

  • Nurse Care Specialist

    1 month ago

    Needham Heights, United States Mass General Brigham Full time

    We are seeking a skilled Nurse Care Specialist to join our team at Mass General Brigham. This is an exciting opportunity for a dedicated and compassionate nurse to provide high-quality care to patients in Needham, Massachusetts.About the Role:This 36-hour per week position involves working night shifts as part of our Float Pool team. As a Nurse Care...

  • Emergency Department Nurse Leader

    4 weeks ago

    Needham Heights, United States Mass General Brigham Full time

    Job OverviewWe are seeking an experienced Registered Nurse to join our team in the Emergency Department at Mass General Brigham in Needham, Massachusetts.About the RoleThis is a 36-hour per week position with a shift of 12 hours, nights. The ideal candidate will have strong interpersonal communication, problem-solving, and conflict management skills.The...

  • Registered Nurse

    6 hours ago

    Needham Heights, United States Mass General Brigham Full time

    Job DescriptionMass General Brigham is seeking a Registered Nurse (RN) Case Management for a nursing job in Needham, Massachusetts.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNDuration: Ongoing32 hours per weekShift: 8 hours, daysEmployment Type: StaffAt Mass General Brigham, we believe in recognizing and rewarding the unique value...

  • Registered Nurse

    7 hours ago

    Needham Heights, United States Mass General Brigham Full time

    Job DescriptionMass General Brigham is seeking a Registered Nurse (RN) Med Surg for a nursing job in Needham, Massachusetts.Job Description & RequirementsSpecialty: Med SurgDiscipline: RNDuration: Ongoing32 hours per weekShift: 8 hours, eveningsEmployment Type: StaffAt Mass General Brigham, we believe in recognizing and rewarding the unique value each team...

  • Registered Nurse

    6 hours ago

    Needham Heights, United States Mass General Brigham Full time

    Job DescriptionMass General Brigham is seeking a Registered Nurse (RN) Med Surg for a nursing job in Needham, Massachusetts.Job Description & RequirementsSpecialty: Med SurgDiscipline: RNStart Date: 09/30/2025Duration: Ongoing24 hours per weekShift: 8 hours, nightsEmployment Type: StaffAt Mass General Brigham, we believe in recognizing and rewarding the...

  • Nurse Care Coordinator

    3 weeks ago

    Needham, United States Mass General Brigham Full time

    At Mass General Brigham, we are seeking a skilled Nurse Care Coordinator to provide quality clinical services to patients in various settings within the community. This role is an excellent opportunity to work with a diverse population and make a meaningful impact on patient care.About the RoleThe ideal candidate will have a strong background in nursing and...

  • LHC Group | staff

    3 hours ago

    needham heights, United States LHC Group Full time

    LHC Group is seeking a Registered Nurse (RN) Home Health for a nursing job in Needham Heights, Massachusetts.Job Description & RequirementsSpecialty: Home HealthDiscipline: RNDuration: OngoingEmployment Type: Staff***Please note that the salary will be commensurate with experience.  SummaryThe Registered Nurse in Home Health provides and directs provisions...

  • Registered Nurse

    1 month ago

    Needham, United States Incredible Health Full time

    Hospitals on Incredible Health are actively hiring and accepting applications in the Needham, MA area for the following position: Registered Nurse - Hospice Case Manager. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Develop and implement personalized care plans, Education and grief, Navigator, Pain...

  • Travel Nursing Professional

    6 days ago

    Warrensville Heights, Ohio, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is currently seeking a highly skilled Registered Nurse to fill a 13-week travel nursing position in Warrensville Heights, Ohio.Job DetailsSpecialty: Med Surg / TelemetryDiscipline: RNDuties:Provide high-quality patient care in a fast-paced hospital settingCollaborate with interdisciplinary teams to ensure seamless patient careWork...

  • Registered Nurse

    1 month ago

    Needham, United States Incredible Health Full time

    Hospitals on Incredible Health are actively hiring and accepting applications in the Needham, MA area for the following position: Registered Nurse - Home Health Case Manager. Nurses with experience in any of the following areas are strongly encouraged to apply: Catheter care and placement, Clinical pathway, Develop and implement personalized care plans,...

  • Healthcare Professional

    1 month ago

    Needham, Alabama, United States Mass General Brigham Full time

    Mass General Brigham is a leading healthcare provider seeking a skilled Medical Surgical Nurse to deliver high-quality patient care in various community settings.About the RoleSpecialty: Medical SurgicalDiscipline: NursingShift: 8 hours, daysEmployment Type: Full-timeKey ResponsibilitiesThe successful candidate will be responsible for providing skilled...

  • Registered Nurse

    7 hours ago

    Needham Heights, United States Mass General Brigham Full time

    Job DescriptionMass General Brigham is seeking a Registered Nurse (RN) Director OR - Operating Room for a nursing job in Needham, Massachusetts.Job Description & RequirementsSpecialty: OR - Operating RoomDiscipline: RNDuration: Ongoing40 hours per weekShift: 8 hours, daysEmployment Type: StaffAt Mass General Brigham, we believe in recognizing and rewarding...

  • Nurse Case Manager

    4 weeks ago

    Needham, Alabama, United States Mass General Brigham Full time

    Job Description:We are seeking a skilled Nurse Case Manager to join our team at Mass General Brigham. In this role, you will play a critical part in ensuring that patients receive the best possible care by coordinating their discharge plans and post-acute care services.About the Job:Location: Needham, MassachusettsShift: 8 hours, daysEmployment Type:...

  • Travel Nurse RN: Medical-Surgical Telemetry Professional

    2 weeks ago

    Warrensville Heights, Ohio, United States Wellspring Nurse Source Full time

    We are seeking a skilled Travel Nurse RN for our medical-surgical telemetry unit. The successful candidate will provide high-quality patient care, working closely with our multidisciplinary team to deliver exceptional outcomes.About the RoleThis is a 13-week contract, working 36 hours per week on 12-hour night shifts. As a travel nurse RN, you will have the...

  • Nurse Case Manager 32 Hour Days

    3 weeks ago

    Needham, United States Mass General Brigham Full time

    Estimate Salary: $80,000 - $110,000 per yearAbout the RoleWe are seeking a skilled Registered Nurse to fill a 32 hour per week Case Management position at Mass General Brigham in Needham, Massachusetts.The ideal candidate will have a strong background in nursing, excellent communication skills, and experience working with patients and healthcare teams to...

  • Nurse Care Coordinator

    4 weeks ago

    Needham Heights, United States Mass General Brigham Full time

    Role OverviewWe are seeking a skilled Nurse Care Coordinator to join our team at Mass General Brigham.This is a full-time, 32-hour-per-week position with an estimated salary of $85,000-$110,000 per year, depending on experience.Job DescriptionThe successful candidate will be responsible for coordinating care for patients across various services, including...

  • Registered Nurse

    14 minutes ago

    Needham, United States Mass General Brigham Full time

    Mass General Brigham is seeking a Registered Nurse (RN) Med Surg for a nursing job in Needham, Massachusetts.Job Description & RequirementsSpecialty: Med SurgDiscipline: RNDuration: Ongoing36 hours per weekShift: 12 hours, nightsEmployment Type: StaffAt Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to...

  • Mass General Brigham | Registered Nurse

    59 minutes ago

    needham, United States Mass General Brigham Full time

    Mass General Brigham is seeking a Registered Nurse (RN) Case Management for a nursing job in Needham, Massachusetts.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNDuration: Ongoing32 hours per weekShift: 8 hours, daysEmployment Type: StaffAt Mass General Brigham, we believe in recognizing and rewarding the unique value each team member...

  • PCU Travel Nurse

    1 month ago

    Richmond Heights, Virginia, United States Travel Nurse Across America Full time

    Job DescriptionWe are seeking a skilled Progressive Care Unit Registered Nurse for an immediate travel nurse opportunity in Richmond, Virginia. The ideal candidate will have 1-2 years of recent acute care experience.Job SummaryThis PCU travel nursing position involves caring for patients who require close monitoring and frequent assessment but are not...