Remote Utilization Review Nurse Auditor — Quality & Compliance

ExamWorks, Inc.; Mount Laurel Township (NJ); Remote; USD 75,000 - 98,000; Full time

Benefits offered by this job

Medical, vision, dental benefits

Paid time off

401k

Job summary

ExamWorks, Inc. is seeking a Utilization Review Nurse Auditor to join our team in a 100% remote capacity. The role focuses on quality utilization review to approve medically necessary care according to evidence-based guidelines and client contracts.

Monday–Friday, 8:00am–5:00pm EST, remote work with rigorous QA and regulatory compliance. The ideal candidate is a licensed nurse with 3–5 years of patient care experience, strong medical knowledge, and proficiency in Microsoft Office.

Qualifications

• High school diploma or equivalent
• Graduate of an accredited nursing program; bachelor's degree preferred
• 3–5 years of direct professional patient care required
• Active unencumbered RN, LPN or LVN required
• Strong knowledge of medical terminology, anatomy & physiology, treatment protocols, medications and labs
• Typing speed of at least 40 WPM
• Ability to operate a computer, fax, copier, scanner, and phone
• Proficiency with multiple software programs, including Microsoft Suite
• Ability to follow instructions and maintain accuracy and quality of work
• Able to work independently, prioritize tasks, and maintain confidentiality
• Support a positive team environment and work well under pressure

Responsibilities

• Perform quality utilization review using evidenced-based guidelines for peer review reports and addenda
• Identify level, intensity and duration of care with providers
• Document findings and evaluate medical necessity for care frequency and length
• Ensure reviews meet industry standards and client requirements
• Adhere to URAC and other regulatory standards and turnarounds
• Maintain accurate utilization review records in the database
• Coordinate with Customer Service to ensure timely delivery of determinations
• Assist in resolution of client complaints and QA issues
• Follow company policies and procedures and participate in training and meetings
• Perform other duties as assigned

Skills

Active nursing license

Medical terminology

Typing 40 WPM

MS Office

Independence

Confidentiality

Team player

Time management

Education

Nursing degree

Tools

Microsoft Office

Job description

ExamWorks, Inc. is seeking a Utilization Review Nurse Auditor to join our team in a 100% remote capacity. The role focuses on quality utilization review to approve medically necessary care according to evidence-based guidelines and client contracts.

Monday–Friday, 8:00am–5:00pm EST, remote work with rigorous QA and regulatory compliance. The ideal candidate is a licensed nurse with 3–5 years of patient care experience, strong medical knowledge, and proficiency in Microsoft Office.