Remote Utilization Review RN - Impactful Case Management

Sedgwick Claims Management Services Ltd; United States; Remote; USD 63,000 - 65,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k and matching

PTO

Disability insurance

Life insurance

Job summary

Sedgwick is seeking a registered nurse to join our utilization review team in a remote environment, providing timely, evidence-based reviews to maximize quality care and cost-effective outcomes for injured employees.

The ideal candidate has an unrestricted RN license, BSN, 2+ years of clinical RN experience, and a preference for case management or related certifications; remote work offers flexibility and professional growth.

Qualifications

• Active unrestricted RN license in a state or territory of the United States required.
• Compact licensure preferred.
• 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.
• Evaluates 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 use of 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; and adheres to ethical, legal, accreditation and regulatory standards.

Education

Bachelor's degree in nursing (BSN)

Active unrestricted RN license

Compact licensure

Certification in case management, pharmacy, rehabilitation nursing or related specialty

Two years of direct clinical RN experience

Job description

Sedgwick is seeking a registered nurse to join our utilization review team in a remote environment, providing timely, evidence-based reviews to maximize quality care and cost-effective outcomes for injured employees.

The ideal candidate has an unrestricted RN license, BSN, 2+ years of clinical RN experience, and a preference for case management or related certifications; remote work offers flexibility and professional growth.