What are the responsibilities and job description for the Utilization Review Nurse (Workers Compensation) - Dallas position at Elite PC Services?
Utilization Review Nurse for Workers' Comp
Job Purpose :
Review Workers Compensation requests submitted by the provider, requestor, claimant or carrier to determine the medical necessity of the treatment utilizing clinical expertise and evidence-based treatment guidelines.
Duties :
- Perform an evaluation of the medical data for utilization review requests.
- Confirm accurate completion of data intake.
- Collect additional relevant data as needed with regard to determining medical necessity.
- Analyze the collected data to apply evidence-based guidelines.
- Review requests and make certification decisions, when appropriate, or prepare a case for peer review referral.
- Coordinates information between all parties (injured worker, physicians, employer, therapists, attorney, etc)
- Participate in audits of work product to ensure compliance.
- Monitor daily processing inventory, including rush / urgent requests.
- Provide inventory information and raise concerns to clinical director.
- Complete production logging.
- Assist leadership team with training and coordinating back-up resources.
Requirements / Skills / Qualifications :
Preferences :