Remote Utilization Review RN: Evidence-Based Care

Sedgwick; Lansing (MI); Remote; USD 80,000 - 110,000; Full time

Job summary

Sedgwick is seeking a Utilization Review RN for a telecommuter role in Michigan. You will review treatment plans, analyze medical records, and determine appropriate care using evidence-based criteria within a collaborative environment.

Required is an active RN license with clinical experience; utilization review certification is a plus. The role emphasizes adherence to standards, accuracy in documentation, and coordination with claim examiners.

Qualifications

• Current unrestricted RN license in the United States.
• RN licensure and clinical background required.
• Utilization review certification preferred.

Responsibilities

• Identifies treatment plan requests and analyzes medical records to support the request.
• Clarifies unclear requests by contacting providers.
• Uses evidence-based criteria to form utilization review determinations.
• Pursues physician advisor involvement when criteria are not met.
• Negotiates treatment plans with providers when appropriate.

Skills

Clinical knowledge

Insurance/claims

Communication skills

PC skills

Analytical skills

Organization

Interpersonal skills

Negotiation

Team player

Performance focus

Education

RN license

Associate degree

Bachelor’s degree preferred

Job description

Sedgwick is seeking a Utilization Review RN for a telecommuter role in Michigan. You will review treatment plans, analyze medical records, and determine appropriate care using evidence-based criteria within a collaborative environment.

Required is an active RN license with clinical experience; utilization review certification is a plus. The role emphasizes adherence to standards, accuracy in documentation, and coordination with claim examiners.