Utilization Review RN

Sedgwick; Columbus (OH); Remote; USD 63,000 - 65,000; Full time

Job summary

Sedgwick, a leading provider in risk and claims management, is seeking an RN to join our US telecommuter team. This full-time role focuses on performing utilization review to maximize patient care quality and cost-efficiency while supporting a flexible work arrangement.

You'll collaborate with physicians, claims staff, and clients to evaluate treatment utilization, ensure privacy, and uphold ethical and regulatory standards. A BSN and active RN license are required.

Qualifications

• Active unrestricted RN license in the United States.
• Bachelor's degree in nursing (BSN) required or equivalent.
• Two years of direct clinical RN experience.
• Case management certification preferred.

Responsibilities

• Performs clinical assessments via medical files; evaluates injured employee’s situation, including psychosocial needs.
• Evaluates patient condition including treatment utilization and compliance; assesses need for and recommends alternative treatment.
• Collaborates with physicians, claims examiners, clients, vendors, supervisors and others as needed.
• Negotiates appropriate level and intensity of care using medical and disability guidelines.
• Maintains client privacy and confidentiality; promotes safety and adheres to standards.
• Performs treatment utilization management reviews.
• Ensures compliance with ethical, legal, accreditation and regulatory standards.

Skills

RN license

BSN

Case management certification

Clinical assessment

Education

Bachelor's degree in nursing (BSN)

Job description

US Telecommuter

Full time

R78360

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

PRIMARY PURPOSE

To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes.

ARE YOU AN IDEAL CANDIDATE?

We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• 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 AND LICENSING

• 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..

TAKING CARE OF YOU

• Seeks innovative customer solutions.


• Craves cutting edge opportunities.


• Wants dynamic company culture.


• Passion about creativity.


• Seeks ongoing learning as a person and professional.


• Thrives when solving challenging problems.


• Wants achievements to be celebrated.


• We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.

#nurse

Work environment requirements may include –

Physical: Computer keyboarding

Auditory/visual: Hearing, vision and talking

Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $63,000-$65,000/year. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com