Remote Utilization Review Nurse

Sedgwick Claims Management Services Ltd; Northern (KY); Hybrid; USD 63,000 - 65,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) plan

PTO

Job summary

Sedgwick Claims Management Services Ltd seeks an RN Utilization Review professional to assess and optimize patient care for injured employees in a remote setting. You will evaluate treatment utilization, collaborate with physicians and claims teams, and promote cost-effective outcomes while safeguarding patient privacy.

The role emphasizes flexible, autonomous work in a supportive, values-driven environment.

Qualifications

• Active unrestricted RN license in a state or territory of the United States required.
• Bachelor's degree in nursing (BSN) from an accredited college or university 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.

Responsibilities

• Performs clinical assessments via information in medical files; assesses injured employee's situation which may include psychosocial needs.
• Evaluates patient condition including treatment utilization and compliance.
• Collaborates with physicians, claims examiners, clients and vendors as needed.
• Negotiates appropriate level and intensity of care using medical and disability guidelines.

Skills

RN license

BSN

Compact licensure

Clinical experience

Case management cert

Education

BSN degree

RN license

Job description

Sedgwick Claims Management Services Ltd seeks an RN Utilization Review professional to assess and optimize patient care for injured employees in a remote setting. You will evaluate treatment utilization, collaborate with physicians and claims teams, and promote cost-effective outcomes while safeguarding patient privacy.

The role emphasizes flexible, autonomous work in a supportive, values-driven environment.