Clinical Nurse Specialist
6 days ago
Elite is seeking a skilled Clinical Nurse Specialist to join our team. As a key member of our Utilization Review department, you will play a crucial role in determining the medical necessity of treatment requests submitted by providers, requestors, claimants, or carriers.
About the Role
This is a challenging and rewarding opportunity for an experienced Registered Nurse to utilize their clinical expertise and evidence-based treatment guidelines to review medical data and make informed decisions. You will work closely with various stakeholders, including injured workers, physicians, employers, therapists, and attorneys, to ensure seamless communication and coordination.
Responsibilities
- Evaluate medical data for utilization review requests, ensuring accurate completion of data intake.
- Collect relevant data as needed to determine medical necessity.
- Analyze collected data to apply evidence-based guidelines.
- Make certification decisions or prepare cases for peer review referral.
- Coolaborate information between all parties (injured worker, physicians, employer, therapists, attorney, etc)
- Participate in audits of work product to ensure compliance.
- Monitor daily processing inventory, including rush/urgent requests.
- Provide inventory information and raise concerns to clinical director.
- Complete production logging.
- Assist leadership team with training and coordinating back-up resources.
Requirements/Skills/Qualifications
- Graduate of an accredited school.
- Valid current RN license in good standing.
- Able to perform the professional and technical skills of a Registered Nurse.
- Minimum 2 years of direct patient care experience.
- Excellent written and oral communication skills.
- Ability to read and interpret medical reports and treatment guidelines.
- Must be able to maintain confidentiality.
- Must possess strong personal organizational skills.
- Must have experience and knowledge of intermediate computer skills.
- Ability to work independently with little to no supervision.
- Ability to work in a fast-paced and time-sensitive environment.
- Ability to meet deadlines in a production-driven environment.
- Ability to work with WORD and EXCEL documents.
Salary
$95,000 - $115,000 per year, depending on experience.
Benefits
Elite offers a comprehensive benefits package, including health insurance, retirement plan, paid time off, and opportunities for professional growth and development.
Contact Information
Please submit your application, including your resume and cover letter, to [insert contact information]. We look forward to hearing from you.
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