Remote Utilization Review Nurse

Sedgwick; Columbus (OH); Remote; USD 63,000 - 65,000; Full time

Job summary

Sedgwick, a leading provider in risk and claims management, is seeking an RN to join our US telecommuter team. This full-time role focuses on performing utilization review to maximize patient care quality and cost-efficiency while supporting a flexible work arrangement.

You'll collaborate with physicians, claims staff, and clients to evaluate treatment utilization, ensure privacy, and uphold ethical and regulatory standards. A BSN and active RN license are required.

Qualifications

• Active unrestricted RN license in the United States.
• Bachelor's degree in nursing (BSN) required or equivalent.
• Two years of direct clinical RN experience.
• Case management certification preferred.

Responsibilities

• Performs clinical assessments via medical files; evaluates injured employee’s situation, including psychosocial needs.
• Evaluates patient condition including treatment utilization and compliance; assesses need for and recommends alternative treatment.
• Collaborates with physicians, claims examiners, clients, vendors, supervisors and others as needed.
• Negotiates appropriate level and intensity of care using medical and disability guidelines.
• Maintains client privacy and confidentiality; promotes safety and adheres to standards.
• Performs treatment utilization management reviews.
• Ensures compliance with ethical, legal, accreditation and regulatory standards.

Skills

RN license

BSN

Case management certification

Clinical assessment

Education

Bachelor's degree in nursing (BSN)

Job description

Sedgwick, a leading provider in risk and claims management, is seeking an RN to join our US telecommuter team. This full-time role focuses on performing utilization review to maximize patient care quality and cost-efficiency while supporting a flexible work arrangement.

You'll collaborate with physicians, claims staff, and clients to evaluate treatment utilization, ensure privacy, and uphold ethical and regulatory standards. A BSN and active RN license are required.