Utilization Review Nurse

To enhance the quality of care in workers' compensation, the full-time Utilization Review Nurse will assess medical necessity, analyze data, and coordinate communication among all parties involved, working remotely during standard business hours. Key responsibilities Perform comprehensive evaluations of medical data to assess medical necessity Coordinate information and discuss care plans with insurance representatives and other stakeholders Participate in annual audits to ensure compliance with established guidelines Required qualifications Graduate of an accredited nursing, chiropractic, or related medical program (RN, DC, PT, DPT, LVN, OT, or LAc) Valid state-specific license in good standing with no restrictions Experience in Utilization Review or Workers' Compensation is preferred Strong organizational skills and proficiency in computer programs (MS Word, MS Excel, Email) Ability to work independently and meet deadlines in a high-pressure environment