Utilization Review Nurse (RN/LVN)

Title: Utilization Review Nurse

Department: Regional Operating Companies

Reports to: Senior Reviewer & Operations Manager

Job Summary

A Utilization Review Nurse position is a full-time, salary position, with an expectation of 50 hours per week. The primary function of a Utilization Review Nurse is to review and analyze medical records for medico-legal reviews. After analyzing provided clinical documentation, Utilization Review Nurses must create a professional executive report that includes a summary, appropriate criteria/guidelines, and a rationale based on evidence based guidelines. The executive summary will review the patient’s condition, physician orders, summarize and discuss course of treatment and substantiate necessity of treatment based on evidence based guidelines. Additional information may be needed in reports as based on the needs of our clients. Utilization Review Nurses are responsible for amending their reports with any additional clinical information provided. Utilization Review Nurses are required to maintain an average daily case load of 25-30 cases per day.

Minimum Requirements

1. Arrive at work on time and ready to work every day

2. LVN or RN with current licensure

3. Completion of Nexus Assessment Test

4. General Typing Skills of 45wpm

5. Knowledge of Microsoft Office 2003 (or more recent)

6. Willing to learn and be trained on medical/surgical procedures

7. Knowledge of basic anatomy

8. Ask for help when needed

9. Support others in a team environment

10. Observe and respect the organizational flow of the office

11. Sign and abide by the confidentiality agreement and Employee Handbook

Essential Job Functions

1. Comprehension of medical/surgical modalities and imaging techniques

2. Analysis of clinical documentation in relation to medico-legal review

3. Interpret and apply appropriate guidelines to medico-legal reviews

4. Use logic and reasoning to determine and utilize appropriate evidence based guidelines

5. Perform a low to moderate amount of research on a case by case basis

6. Create a high-quality, professional report free of grammar or spelling errors

7. Dictate all report information

8. Reach and maintain a 25-30 average case load per day after released from training

9. Maintain a monthly Quality Assurance score of 99% or higher

*To Apply:  Email your resume to careershere@sedonagroup.com and Apply on-line at www.sedonacompass.com (be sure to fill out EACH section COMPLETELY).

*Once we receive your resume and completed application, someone will call you for an initial interview.