RN Utilization Review
Posted on: June 23, 2022
**The 'Apply with SEEK' option will be utilized for
International applicants, mainly Australia. If this does not apply
to you please use the 'Apply' option.**
RN Utilization Review
IF YOU CARE, THERE'S A PLACE FOR YOU HERE
For a career path that is both challenging and rewarding, join
Sedgwick's talented team of 27,000 colleagues around the globe.
Sedgwick is a leading provider of technology-enabled risk, benefits
and integrated business solutions. Taking care of people is at the
heart of everything we do. Millions of people and organizations
count on Sedgwick each year to take care of their needs when they
face a major life event or something unexpected happens. Whether
they have a workplace injury, suffer property or financial loss or
damage from a natural or manmade disaster, are involved in an auto
or other type of accident, or need time away from work for the
birth of a child or another medical situation, we are here to
provide compassionate care and expert guidance. Our clients depend
on our talented colleagues to take care of their most valuable
assets-their employees, their customers and their property. At
Sedgwick, caring counts -. Join our team of creative and caring
people of all backgrounds, and help us make a difference in the
lives of others.
**PRIMARY PURPOSE** : To provide timely, evidence-based utilization
review services to maximize quality care and cost-effective
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Identifies treatment plan request(s) and obtains and analyzes
medical records that support the request.
+ Clarifies unclear treatment plan requests by contacting the
requesting provider's office.
+ Utilizes evidence-based criteria and jurisdictional guidelines to
form utilization review determinations.
+ Pursues Physician Advisor services when treatment plan requests
do not meet evidenced-based criteria.
+ Negotiates treatment plan requests with requesting provider when
medically appropriate and jurisdictionally allowed.
+ Channels certified treatment plan requests to preferred vendors
+ Documents all utilization review outcomes in utilization review
+ Communicates and works with claim examiners as needed to provide
clinical information to resolve issues.
+ Maintains a score of 90% or higher on monthly internal
utilization review audits.
+ Meets productivity goals as outlined by supervisor.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s)
**Education & Licensing**
Active unrestricted RN license in a state or territory of the
United States required. Bachelor's or Associate degree from an
accredited college or university preferred. Utilization review
based certification strongly preferred.
Four (4) years of related experience or equivalent combination of
education and experience required to include two (2) years of
recent clinical practice **OR** one (1) year of recent utilization
**Skills & Knowledge**
+ Strong clinical practice knowledge
+ Knowledge of the insurance industry and claims processing
+ Excellent oral and written communication, including presentation
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Excellent negotiation skills
+ Ability to work in a team environment
+ Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to
**Mental:** Clear and conceptual thinking ability; excellent
judgment, troubleshooting, problem solving, analysis, and
discretion; ability to handle work-related stress; ability to
handle multiple priorities simultaneously; and ability to meet
**Physical:** Computer keyboarding, travel as required
**Auditory/Visual:** Hearing, vision and talking
As required by law, Sedgwick provides a reasonable range of
compensation for roles that may be hired in (Colorado or New York
City). 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 state noted in this job posting
only, the range of starting pay for this role is $54,838 - $76,875.
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
The statements contained in this document are intended to describe
the general nature and level of work being performed by a colleague
assigned to this description. They are not intended to constitute a
comprehensive list of functions, duties, or local variances.
Management retains the discretion to add or to change the duties of
the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free
Keywords: Sedgwick, Harrisburg , RN Utilization Review, Other , Harrisburg, Pennsylvania
Didn't find what you're looking for? Search again!