Utilization Review Nurse (Workers' Comp)

at  Encompass Health Solutions Inc

Encompass Workers’ Comp Solutions provides Case Management and Utilization Review services in the California Workers’ Compensation industry. We are currently looking for a Utilization Review Nurse to work from home. Monday-Friday 8 hours per day.

JOB DESCRIPTION:

The UR Nurse provides Workers’ Compensation Utilization Review services to Encompass clients, reviewing requests for treatment authorization in accordance with state/federal specific mandates, laws and regulations. The goal of the UR Nurse is to assure medically appropriate treatment is approved as quickly as possible in order to expedite the injured employee’s recovery and return to work.

REQUIREMENTS:

• Active unrestricted California Licensed Vocational Nurse (“LVN”) or California Registered Nurse ("RN")
• Must be physically located within California
• Minimum of three (3) years recent acute care experience (Preferably in one or more of the following: Emergency Department, Occupational Medicine, Intensive Care/Coronary Care, and Orthopedics/Neurology.)
• Prior experience in California Workers’ Compensation Utilization Review preferred
• Excellent grammar and spelling skills.
• Proficiency with Microsoft Office Suite, Internet Explorer, Google Chrome, etc.
• Ability to navigate several software systems concurrently.
• Must be able to type a minimum of 45 WPM.
• Ability to handle multiple tasks simultaneously in a fast-paced environment.
• High attention to detail.
• Superior organizational and time management skills
  You can visit our website at encompasswc.com for more information on the organization. Please submit your resume for immediate consideration

• Initially applies specified clinical criteria to requests for authorization for medical services
• Determines if the medical reports are adequate to make a determination on treatment request or determines that additional medical information is necessary. Requests additional medical reports necessary to complete utilization review, as indicated.
• Compares the information to established clinical criteria and determines medical necessity. (These comparisons are made using accepted evidence-based guidelines)
• Uses analytical skills in nursing to make determination of comparisons of the treatment request to established and accepted medical guidelines.
• Determines through comparison of guideline choices, which guideline set best meets the patient’s needs and/or uses guidelines set forth per state specific mandates.
• Provides a recommendation based on their assessment of the clinical information, appropriate evidence-based guidelines, and possible discussion with the requesting provider.
• Communication to all parties is adhered to as outlined in state specific regulations (if any) otherwise through client directives or internal policies.