Utilization Review Nurse

PRIMARY PURPOSE OF THE ROLE To utilize evidence-based tools to evaluate the prescribed treatment to ensure patient safety and quality standards are in alignment with best practice standards. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment and who are driven to deliver great work. 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. ESSENTIAL RESPONSIBILITIES MAY INCLUDE Perform clinical assessments via information in medical files; assess injured employee’s situation which may include psychosocial needs. Evaluate patient condition including treatment utilization and compliance; evaluate need for and recommend alternative treatment. Collaborate effectively with physicians, claims examiners, clients, vendors, supervisors and other parties as needed. Negotiate appropriate level and intensity of care through use of medical and disability guidelines, adhering to quality assurance standards. Act as a resource in consulting with the client, nursing staff and claims examiners regarding treatment issues. Perform treatment utilization management reviews. Maintain client’s privacy and confidentiality; promote client safety and advocacy; and adhere to ethical, legal, accreditation and regulatory standards. Offer a diverse and comprehensive benefits package including medical, dental, vision, 401(k), PTO and more beginning your first day. 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 BY Seeks innovative customer solutions Seeks ongoing learning as a professional and a person Thrives when solving challenging problems Seeks clear role expectations Metrics, policies, processes are helpful Seeks to contribute to a larger purpose Thrives when everyone is working towards the same vision and goals Strong team and customer service orientation 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. BENEFITS AND COMPENSATION Salary range: $63,000 - $65,000. Comprehensive benefits package includes medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. #J-18808-Ljbffr