Part-Time Utilization Review Nurse Auditor (Remote)

Requisition ID
2022-8496
# of Openings
1
Category
Operations
Location
US-MA-Woburn

Overview

ATTENTION all nurses with a Massachusetts RN license!!! 

 

This is a PART-TIME postion, 4 hours per day, 2 days a week. Ideally this would be an on-site position in Woburn, MA. Specifics of schedule will be discussed

 

 

The Utilization Review Nurse Auditor is responsible for performing quality utilization review services and approving care that is medically necessary and appropriate according to evidenced base guidelines and criteria. This position interacts daily with the Peer Review Services Department along with clients, providers, and various other interdepartmental personnel. This position ensures reports are completed with the highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates.

Responsibilities

 

  • Perform quality utilization review through the use of acquired knowledge and application of evidenced based guidelines for peer review reports, correspondences, addendums and/or supplemental reviews.
  • Works direct with providers to identify level, intensity and duration of care.
  • Documents findings, continues to evaluate medical necessity for frequency, intensity and length of required
  • Assures that the consistency and quality of reviews meets or exceeds industry standards.
  • Works to ensure quality reviews are completed within the required client, federal and state or URAC mandated turnaround times.
  • Maintain and apply knowledge of URAC and other state and federal regulatory requirements.
  • Maintains accurate record of Utilization Reviews within the appropriate database.
  • Direct Customer Service Representatives to ensure timely delivery of determination letters.
  • Assists in resolution of client complaints and/or quality assurance issues as needed.
  • Ensures all quality assurance standards and federal ERISA, URAC, and/or other state guidelines are adhered to at all times.

 

 

Qualifications

 

  • Massachusetts RN license required
  • Associates degree required, Bachelors degree preferred
  • Minimum of three to five years of direct professional patient care required.
  • Orthopedic or family medicine experience is highly preferred
  • Experience in utilization management preferred.
  • Must have strong knowledge of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values
  • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet
  • Must possess excellent skills in English usage, grammar, punctuation and style
  • Ability to follow instructions and respond to upper managements’ directions accurately
  • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met
  • Must be able to maintain confidentiality

 

 

 

 

 

WHO WE ARE

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

 

ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

 

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

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