RN Utilization Review

RN Utilization Review

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

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

Work environment requirements may include –Physical: Computer keyboardingAuditory/visual: Hearing, vision and talkingMental: 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.

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.