Utilization Review Nurse Auditor (32967)

Paycom - ATS; Mount Laurel Township (NJ); On-site; USD 45,000 - 63,000; Full time

Benefits offered by this job

Medical, Vision, Dental

Paid time off

401k

Job summary

ExamWorks is seeking a Utilization Review Nurse Auditor to perform quality utilization reviews and approve medically necessary care according to evidence-based guidelines. The role is 100% remote with a Mon-Fri schedule 8:00am-5:00pm EST, Mt Laurel, NJ area.

Requirements include an accredited nursing degree, active RN/LPN/LVN license, and 3–5 years of direct patient care. URAC and regulatory knowledge are preferred; travel is minimal.

Qualifications

• Graduate of an accredited nursing program; bachelor’s degree preferred.
• Active RN/LPN/LVN license required.
• 3–5 years direct professional patient care experience.

Responsibilities

• Perform quality utilization review for peer reviews and reports.
• Identify level, intensity and duration of care with providers.
• Document findings and evaluate medical necessity.
• Ensure reviews meet URAC and client standards and turnaround times.
• Maintain URS records and assist in client issue resolution.

Skills

Nursing knowledge

Medical terminology

Data entry (40 WPM)

Microsoft Office

Independent work

Confidentiality

Team collaboration

Adaptability under pressure

Education

Nursing degree

Tools

Microsoft Office

Job description

Job Details: Job Location: Mt Laurel NJ (Prizm) - Mount Laurel, NJ, Position Type: Full Time, Salary Range: $33.00 - $46.00Hourly, Travel Percentage: 10%, ExamWorks is looking for a Utilization Review Nurse Auditor to join their team!

The Utilization Review Nurse Auditor is responsible for performing quality utilization review services and approving care that is medically necessary and appropriate according to evidence-based guidelines and criteria. This position ensures reports are completed with the highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates.

The position is 100% remote with a schedule of Monday through Friday:8:00am-5:00pm EST

• Perform quality utilization review through the use of acquired knowledge and application of evidence-based guidelines for peer review reports, correspondences, addendums and/or supplemental reviews.
• Work directly with providers to identify level, intensity and duration of care.
• Document findings, continue to evaluate medical necessity for frequency, intensity and length of required care.
• Assure that the consistency and quality of reviews meets or exceeds industry standards.
• Work to ensure quality reviews are completed within the required client, federal and state or URAC mandated turnaround times.
• Maintain and apply knowledge of URAC and other state and federal regulatory requirements.
• Maintain accurate record of Utilization Reviews within the appropriate database.
• Direct Customer Service Representatives to ensure timely delivery of determination letters.
• Assist in resolution of client complaints and/or quality assurance issues as needed.
• Ensure all quality assurance standards and federal ERISA, URAC, and/or other state guidelines are adhered to at all times.
• Provide insight and direction to management on any compliance concerns regarding products, company policies and procedures and/or client specifications.
• Participate in company meetings, training activities and continuing education requirements.
• Perform all other duties as assigned.

Qualifications:

• High school diploma or equivalent required.
• Must be a graduate of an accredited nursing program; bachelor’s degree preferred.
• Minimum of three to five years of direct professional patient care required.
• Experience in utilization management preferred.
• Active unencumbered Registered Nurse, Licensed Practical Nurse or Licensed Vocational Nurse required.
• Must have strong knowledge of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values.
• Must be a qualified typist with a minimum of 40 W.P.M.
• Must be able to operate a general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Suite.
• Ability to follow instructions and respond to upper managements’ directions accurately.
• Must demonstrate accuracy, thoroughness, and responsibility for quality of work, and ability to take initiative to identify improvements. Look for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.
• Must be able to stay focused and concentrate with frequent interruptions and be able to work well under pressure and or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

ExamWorks, LLC is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

• medical, vision, dental
• paid time off
• 401k