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Utilization Review Nurse-Workers' Compensation Job
Date: Nov 6, 2009
Location: Buffalo, NY, US
Job Title: Utilization Review Nurse-Workers' Compensation
Job ID: 790477
Location: NY-Buffalo
Available Openings: 2
Committed. Competitive. Constructing our Future.
That's Travelers. We are one of the leading insurance companies in the United States. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy, and a workplace in which you truly can make a difference.
In-house telephonic utilization review for prospective, concurrent, retrospective and appeal treatment requests for workers' compensation claims
Responsible for adhering to the Massachusetts and California Utilization Review Criteria.
Job Components:
Contact ordering provider upon notification of request for treatment to obtain pertinent medical findings. Information may be received telephonically, electronically or via mail.
Assess medical case facts and apply critical thinking skills to determine medical necessity of requested treatment for prospective, concurrent and retrospective reviews, applying review criteria and treatment guidelines.
UR determinations are supported with clinical rationale and concisely documented.
Facilitate Peer Advisor review for second level determinations when indicated per established Best Practices
Provide written and verbal notification of review determinations.
Perform other duties as required.
Qualifications/Requisite Skills:
RN/LPN licensure required (as per state requirements)
Related clinical experience preferred (orthopedics, neurology, occupational health, Utilization Review)
Strong computer skills
Strong customer focus/communication and relationship management skills
Travelers is an equal opportunity employer. We actively promote a drug-free workplace.
Job ID: 790477
Location: NY-Buffalo
Available Openings: 2
Committed. Competitive. Constructing our Future.
That's Travelers. We are one of the leading insurance companies in the United States. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy, and a workplace in which you truly can make a difference.
In-house telephonic utilization review for prospective, concurrent, retrospective and appeal treatment requests for workers' compensation claims
Responsible for adhering to the Massachusetts and California Utilization Review Criteria.
Job Components:
Contact ordering provider upon notification of request for treatment to obtain pertinent medical findings. Information may be received telephonically, electronically or via mail.
Assess medical case facts and apply critical thinking skills to determine medical necessity of requested treatment for prospective, concurrent and retrospective reviews, applying review criteria and treatment guidelines.
UR determinations are supported with clinical rationale and concisely documented.
Facilitate Peer Advisor review for second level determinations when indicated per established Best Practices
Provide written and verbal notification of review determinations.
Perform other duties as required.
Qualifications/Requisite Skills:
RN/LPN licensure required (as per state requirements)
Related clinical experience preferred (orthopedics, neurology, occupational health, Utilization Review)
Strong computer skills
Strong customer focus/communication and relationship management skills
Travelers is an equal opportunity employer. We actively promote a drug-free workplace.
Nearest Major Market: Buffalo
Job Segments: Compensation, Healthcare, Human Resources, Nursing
Apply now »
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