Nurse Utilization Specialist
4 weeks ago
Nurse Utilization Specialist
Job Summary:
Elite is seeking a skilled Nurse Utilization Specialist to join our team. As a key member of our clinical review team, you will play a critical role in ensuring the medical necessity of treatment requests submitted by providers, requestors, claimants, or carriers.
Responsibilities:
- Conduct thorough evaluations of medical data for utilization review requests.
- Verify accurate completion of data intake and collect additional relevant data as needed.
- Analyze collected data to apply evidence-based guidelines and make certification decisions or prepare cases for peer review referral.
- Coordinate information between all parties, including injured workers, physicians, employers, therapists, and attorneys.
- Participate in audits to ensure compliance and monitor daily processing inventory, including rush/urgent requests.
- Provide inventory information and raise concerns to the clinical director.
- Complete production logging and assist the leadership team with training and coordinating back-up resources.
Requirements:
- Graduate of an accredited school of nursing.
- Valid current LVN, LPN, or 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 and possess strong personal organizational skills.
- Must have experience and knowledge of intermediate computer skills.
- Ability to work independently with little to no supervision and meet deadlines in a production-driven environment.
Preferred Qualifications:
- Experience in utilization review specific to workers' compensation is a plus.
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