Utilization Nurse

Requisition ID
2017-1468
# of Openings
10
Category
Operations
US-IL-Rockford

Overview

Looking to transition away from bedside care? Apply your clinical experience in an administration role? Well come check us out!!!! We are seeking a skilled RN or LPN with experience in utilization, case management, care plan development, clinical documentation, and/or peer review to serve as a Clinical Quality Assurance Coordinator. Someone who is passionate about compliance and quality assurance Monday through Friday and likes having their weekends and evenings free. While we also in believe weekends, we truly believe in our service and apparently a lot of insurance companies do as well as we have shown tremendous growth over the last 8 years and are now proud to say that we’re a global company.

 

 

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

  • Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
  • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
  • Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
  • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
  • Ensures the provider credentials and signature are adhered to the final report.
  • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.

Qualifications

EDUCATION AND/OR EXPERIENCE 

  • Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred.
  • A minimum of two years clinical or related field experience; or equivalent combination of education and experience.
  • Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability preferred.

 debbie.brown@examworks.com

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