Clinical Review Specialist for Workers' Compensation

2 months ago


Dallas, Texas, United States Elite Full time
Job Summary

We are seeking a highly skilled Utilization Review Nurse to join our team at Elite. 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.

Key Responsibilities
  • Medical Necessity Review: Conduct thorough evaluations of medical data for utilization review requests, applying evidence-based treatment guidelines to determine the necessity of treatment.
  • Data Collection and Verification: Confirm accurate completion of data intake and collect additional relevant data as needed to support medical necessity decisions.
  • Certification and Peer Review: Make certification decisions, when appropriate, or prepare cases for peer review referral, ensuring compliance with regulatory requirements.
  • Communication and Coordination: Coordinate information between all parties involved, including injured workers, physicians, employers, therapists, and attorneys.
  • Inventory Management: Monitor daily processing inventory, including rush/urgent requests, and provide inventory information to the clinical director.
  • Production Logging and Quality Assurance: Complete production logging and participate in audits of work product to ensure compliance with quality standards.
Requirements and Qualifications
  • Education and Licensure: Graduate of an accredited school and valid current RN license in good standing.
  • Experience and Skills: Minimum 2 years of direct patient care experience, excellent written and oral communication skills, ability to read and interpret medical reports and treatment guidelines, and strong personal organizational skills.
  • Technical Skills: Intermediate computer skills, ability to work with WORD and EXCEL documents, and experience with electronic medical records.
Preferred Qualifications
  • Utilization Review Experience: Experience in utilization review, particularly in workers' compensation, is highly desirable.


  • Dallas, Texas, United States Elara Caring Full time

    At Elara Caring, we strive to provide exceptional care to our patients in the comfort of their own homes. To achieve this goal, we need a dedicated Workers Compensation Specialist to ensure that our employees receive the support they need in case of work-related injuries.The ideal candidate will have a strong background in claims management, risk assessment,...


  • Dallas, Texas, United States Concentra Full time

    Job Title: Medical Review SpecialistConcentra is seeking a Medical Review Specialist to join our team. As a Medical Review Specialist, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family...


  • Dallas, Texas, United States Concentra Career Choice Full time

    Job SummaryWe are seeking a highly skilled and experienced Medical Review Specialist to join our team at Concentra Career Choice. As a Medical Review Specialist, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, and return to work, short and...


  • Dallas, Texas, United States Elite PC Services Full time

    Job Title: Clinical Review NurseJob Summary:Elite PC Services is seeking a skilled Clinical Review Nurse to join our team. As a Clinical Review Nurse, you will play a critical role in reviewing Workers Compensation requests to determine medical necessity. Your expertise will be utilized to analyze medical data, apply evidence-based guidelines, and make...


  • Dallas, Texas, United States TEKsystems Full time

    Job Title: Workers Compensation Claims SpecialistAt TEKsystems, we're seeking a highly skilled Workers Compensation Claims Specialist to join our team. As a key member of our hearing care customer service team, you will be responsible for providing exceptional service to our customers, ensuring timely and authentic follow-up throughout the workers...

  • Nurse Case Manager

    5 days ago


    Dallas, Texas, United States Spectrum Healthcare Resources Full time

    Job Title: Nurse Case Manager - Workers' Compensation SpecialistJob Summary:Spectrum Healthcare Resources is seeking a skilled Nurse Case Manager to support the United States Department of Labor, Office of Workers' Compensation (OWCP) and the Division of Federal Employees' Compensation (DFEC). As a Nurse Case Manager, you will provide nursing services to...


  • Dallas, Texas, United States North Texas Compensation Association Full time

    Job Summary:North Texas Compensation Association is seeking a highly skilled Director of Compensation to lead the development, implementation, and management of broad-based compensation strategies and programs. This role will be integral in leading the compensation function and will report into the Vice President of Total Rewards and HRIS. The ideal...


  • Dallas, Texas, United States Arlington Independent School District Full time

    Job SummaryWe are seeking a highly skilled Workers Compensation Claims Adjuster to join our team at Arlington Independent School District. As a key member of our risk management team, you will be responsible for reviewing, examining, investigating, analyzing, and processing workers' compensation claims.Key ResponsibilitiesConduct research and analyze...


  • Dallas, Texas, United States Elara Caring Full time

    Workers Compensation Specialist Job DescriptionAt Elara Caring, we have a unique opportunity to play a pivotal role in the growth of our home care industry.We are seeking an elite team member to join our healthcare professionals in providing Right Care, at the Right Time, in the Right Place.Key Responsibilities:Ensuring federal and state guidelines for job...


  • Dallas, Texas, United States Arlington Independent School District Full time

    Job SummaryWe are seeking a highly skilled Workers Compensation Claims Adjuster to join our team at Arlington Independent School District. As a key member of our risk management team, you will be responsible for reviewing, examining, and processing workers' compensation claims in a timely and efficient manner.Key ResponsibilitiesConduct thorough...


  • Dallas, Texas, United States UnitedHealth Group Full time

    Clinical Outpatient ReviewerAt UnitedHealth Group, we are seeking a skilled Clinical Outpatient Reviewer to join our team. As a key member of our clinical review team, you will be responsible for performing thorough reviews of professional and facility claims against medical records to ensure accuracy and compliance.Key Responsibilities:Conduct clinical...

  • Nurse Case Manager

    4 days ago


    Dallas, Texas, United States Spectrum Healthcare Resources Full time

    Job Summary:Spectrum Healthcare Resources is seeking a skilled Registered Nurse to fill a Case Manager position in support of the United States Department of Labor, Office of Workers' Compensation (OWCP) and the Division of Federal Employees' Compensation (DFEC).The ideal candidate will have a minimum of two years of adult medical/surgical nursing experience...


  • Dallas, Texas, United States University of Texas Southwestern Medical Center Full time

    Job SummaryAs a Clinical Utilization Review Specialist at the University of Texas Southwestern Medical Center, you will play a crucial role in ensuring the highest quality of care for our patients. Your primary responsibility will be to conduct medical certification reviews for medical necessity for acute care facilities and services.You will use nationally...

  • Nurse Case Manager

    1 week ago


    Dallas, Texas, United States Spectrum Healthcare Resources Full time

    Job Summary:Spectrum Healthcare Resources is seeking a skilled Registered Nurse to fill a Case Manager position in support of the United States Department of Labor, Office of Workers' Compensation (OWCP) and the Division of Federal Employees' Compensation (DFEC).Key Responsibilities: Provide nursing services to injured Federal workers in person and...


  • Dallas, Texas, United States CCMS & Associates Full time

    {"h1": "Senior Workers' Compensation Adjuster Job Description", "p": "At CCMS & Associates, we are seeking a highly skilled Senior Workers' Compensation Adjuster to join our team. This is a 1099 remote position that offers the opportunity to work with a fast-growing independent adjusting and Third Party Administration firm. Responsibilities: * Investigate...


  • Dallas, Texas, United States CCMS & Associates Full time

    {"h1": "Senior Workers' Compensation Adjuster Job Description", "p": "CCMS & Associates is seeking a licensed Texas adjuster with 5 years of experience in lost time workers' compensation claims. This is a 1099 remote position with potential to convert to a team lead or supervisor upon assessment and performance evaluations.", "ul": [{"li": "High School...


  • Dallas, Texas, United States CCMS & Associates Full time

    Job OverviewCCMS & Associates is seeking a highly skilled Senior Workers' Compensation Adjuster to join their team. This is a 1099 remote position that requires a licensed Texas adjuster with 5 years of experience in lost time workers' compensation claims.The ideal candidate will have a strong background in investigating and administering Liability and/or...


  • Dallas, Texas, United States CCMS & Associates Full time

    Job OpportunityCCMS & Associates is seeking a seasoned Workers' Compensation Adjuster to join our team. This is a 1099 remote position that offers a unique opportunity to work with a fast-growing independent adjusting and Third Party Administration firm.We are looking for a licensed Texas adjuster with 5 years of experience in lost time workers' compensation...


  • Dallas, Texas, United States Stealth Recruiting Services Full time

    Job DescriptionOur client, a premiere defense law firm, is seeking a Senior Attorney with a minimum of 1 year of experience in workers' compensation law to join their remote team in California.Key Responsibilities:Manage the legal defense of workers' compensation cases from inception to final resolutionAdvocate on behalf of insurance carriers, 3rd party...


  • Dallas, Texas, United States AmTrust Financial Full time

    Job Summary:AmTrust Financial Services is seeking a skilled Complex Workers' Compensation Claims Adjuster to join our team. The successful candidate will handle complex claims, including Workers Compensation related claims, and evaluate coverage issues and risk transfer opportunities.Key Responsibilities:Evaluate coverage issues and risk transfer...