Utilization Review RN

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

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 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 RESPONSIBILITIES 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.

WORK ENVIRONMENT REQUIREMENTS

• Physical: Computer keyboarding
• Auditory/visual: Hearing, vision and talking
• Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines

COMPENSATION AND BENEFITS

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.

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

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

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.

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