Utilization Review Nurse

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

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Utilization Review Nurse

PRIMARY PURPOSE OF THE ROLE: To utilize evidence-based tools to evaluate the prescribed treatment to ensure patient safety and quality standards are in alignment with best practice standards.

ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

• 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 the best of both worlds – 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 your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting.
• 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.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• 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; and adheres to ethical, legal, accreditation and regulatory standards.
• We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.

EDUCATION AND LICENSING

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.

​TAKING CARE OF YOU BY

• Seeks innovative customer solutions
• Seeks ongoing learning as a professional and a person
• Thrives when solving challenging problems
• Seeks clear role expectations
• Metrics/policies/processes are helpful
• Seeks to contribute to a larger purpose
• Thrives when everyone is working towards same vision/goals
• Strong team and customer service orientation

Work environment requirements for entry-level opportunities include –
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

NEXT STEPS

If your application is selected to advance to the next round, a recruiter will be in touch.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $63,000 – $65,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.