[Hiring] Utilization Review RN @Sedgwick

Role Description

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

• Apply your RN clinical knowledge and experience to assist in the management of complex medical conditions, treatment planning, and recovery from illness or injury.
• Work in a rewarding career making an impact on the health and well-being of others in a remote work environment.
• Enjoy flexibility and autonomy in your daily work and career path while advocating for effective and efficient medical treatment for injured employees.
• Enable our Caring Counts® mission of supporting injured employees from some of the world’s best brands and organizations.
• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
• Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives, and more.
• Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs.

Qualifications

• 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.

Requirements

• 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; adheres to ethical, legal, accreditation, and regulatory standards.

Benefits

• Diverse and comprehensive benefits including medical, dental, vision, 401K, PTO, and more beginning your first day.