Utilization Review Nurse

Dallas, TX
Jun 13, 2017
Jobs Outside Higher Education
Other Jobs Outside Higher Education
Institution Type
Outside Academe

Job Description


Position Summary (In-Office): To perform utilization review for workers' compensation claims based on review criteria and protocols in accordance with state and regulatory agency compliance. This is a position that requires critical thinking and problem solving skills with effective written and oral communication skills. The environment is fast-paced and ever-changing.

Technical Knowledge, Experience and Skills Requirements/Preferences:

1. Valid RN licensure or LVN licensure
2. Prior experience in a managed care or utilization review agency environment OR emergency/trauma nursing.
3. Proficiency using personal computers and software programs, including Word, and typing a minimum of 30 wpm.

1. Organized and detail oriented.

2. Strong ability to review medical records and identify critical details impacting medical necessity determinations.

3. Must be self-motivated, independent and accountable. Strength in multi-tasking and clinical prioritization required.

Key Accountabilities:

1. Provides utilization review via analysis of medical data on an average number of UR requests per day.
2. Perform prospective, concurrent and retrospective reviews to certify medical necessity and appropriateness of requested services.
3. Communicates timely decisions, both verbally and written, according to NOVARE policies and procedures.
4. Documents clinical criteria utilized to perform reviews and support determinations.
5. Documents utilization decisions in appropriate system data fields focusing on data integrity.
6. Reviews all requests that do not meet clinical review criteria with Medical Director for final determination.
7. Assists in UR file preparations to ensure completeness and accuracy upon notice of reconsideration or appeal.
8. Performs other related projects and duties as assigned

Location: Dallas, TX (Dallas North Tollway/Beltline)

Company Description
Novare was founded in 2001 and remains an independent privately held, workers compensation cost Containment Company. Novare has a staff of professional nurse case managers, vocational rehab specialists, utilization management nurses and medical bill review analysts. Novare is committed to efficient and effective cost containment with a high responsibility to quality, service and local representation. Our services are uniquely customized to meet our customers specific needs. Our staff is highly professional and among the most experienced and innovative in the industry.

Dallas, TX


Sat, 10 Jun 2017 08:14:04 PDT