Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning, and recovery for injured employees while advocating for effective medical treatment. Key responsibilities Perform clinical assessments and evaluate patient conditions, treatment utilization, and compliance Collaborate with physicians, claims examiners, and other stakeholders to negotiate appropriate care levels Maintain client confidentiality and adhere to ethical, legal, and regulatory standards while performing utilization management reviews Required qualifications Active unrestricted RN license in a state or territory of the United States; compact licensure preferred Bachelor's degree in nursing (BSN) from an accredited institution or equivalent work experience preferred Certification in case management, pharmacy, rehabilitation nursing, or a related specialty is highly preferred Two (2) years of direct clinical experience as an RN is required
Utilization Review RN in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.