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

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

Utilization Review RN

As a nurse at Sedgwick, you can build a meaningful and rewarding career while advocating for patients in a nontraditional clinical setting.

• Apply your RN clinical knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury.
• Work in the best of both worlds - a rewarding career making an impact on the health and well-being of others in a remote work environment.
• Enjoy flexibility and autonomy in your daily work and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting.
• Enable our Caring Counts® mission of supporting injured employees from some of the world’s best brands and organizations.
• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
• Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more.
• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

PRIMARY PURPOSE:To provide timely, evidence-based utilization review services to maximize quality care andcost-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.

Sedgwickis 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.