Remote Utilization Review RN

Sedgwick; United States; Remote; USD 63,000 - 65,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) with match

PTO

HSA/FSAs

Job summary

Sedgwick is seeking an Utilization Review RN to provide timely, evidence-based utilization review services in a remote setting, maximizing quality care and cost-effective outcomes. Ideal candidates will have active RN licensure and relevant clinical experience.

The role emphasizes collaboration with physicians, claims examiners, and clients, along with adherence to regulatory standards and patient confidentiality. Flexible benefits and remote access are highlighted in the posting.

Qualifications

• Active unrestricted RN license in the United States required.
• Bachelor's degree in nursing (BSN) from an accredited college or university preferred; related work experience may be considered.
• Two (2) years of direct clinical experience as an RN is required; certification in case management or related specialty is highly preferred.

Responsibilities

• Performs clinical assessments via information in medical files; assesses injured employee’s situation including psychosocial needs.
• Evaluates patient condition including treatment utilization and compliance; assesses need for and recommends alternative treatment.
• Collaborate effectively with physicians, claims examiners, clients, vendors, supervisors and other parties as needed.
• Negotiates appropriate level and intensity of care through medical and disability guidelines, adhering to quality assurance standards.
• Acts as a resource in consulting with the client, nursing staff and claims examiners regarding treatment issues.
• Performs treatment utilization management reviews.
• Maintains client's privacy and confidentiality; promotes client safety and advocacy; adheres to ethical, legal, accreditation and regulatory standards.

Skills

RN license

Clinical assessment

Healthcare experience

Collaboration

Education

BSN degree

Case management certification

2+ years RN experience

Job description

Sedgwick is seeking an Utilization Review RN to provide timely, evidence-based utilization review services in a remote setting, maximizing quality care and cost-effective outcomes. Ideal candidates will have active RN licensure and relevant clinical experience.

The role emphasizes collaboration with physicians, claims examiners, and clients, along with adherence to regulatory standards and patient confidentiality. Flexible benefits and remote access are highlighted in the posting.