What are the responsibilities and job description for the Utilization Review Nurse - Workers Compensation position at Travelers Insurance?
Who Are We?
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
79,400.00 - $130,900.00
Target Openings
What Is the Opportunity?
This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective, concurrent, retrospective and appeal treatment requests for workers compensation claims. Responsible for helping to ensure the appropriate treatment is directly related to the compensable injury and for adhering to multi-jurisdictional Utilization Review criteria.
What Will You Do?
- Interpret routine, complex or unique medical information.
- Evaluate medical treatment to determine whether it was / is reasonable, necessary and causally related based upon jurisdictional guidelines.
- Submit accurate billing documentation on all activities as outlined in established guidelines.
- Engage specialty resources, as needed, to reach final determination of medical necessity.
- Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
- Utilize Preferred Provider Network per jurisdictional guidelines.
- Research medical information to support the claim review process.
- Occasional contact with provider to ensure the injured employee is actively participating in a viable treatment plan.
- Keep claim professional apprised of medical treatment request status.
- In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
- Perform other duties as assigned.
What Will Our Ideal Candidate Have?
What is a Must Have?
What Is in It for You?
Employment Practices
Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit http : / / careers.travelers.com / life-at-travelers / benefits / .
Salary : $79,400 - $130,900
