RN Reviewer, Workers' Compensation Utilization Review

This is a fully remote position, open to applicants in Washington.

📋 Description

• Conduct independent external medical reviews remotely on an as-needed basis as an independent contractor.

• Assess workers' compensation cases according to the reviewer’s area of expertise for medical necessity and/or adherence to standard care.

• Examine treatment requests and medical records to ensure medical necessity and compliance with guidelines.

• Implement Workers' Compensation Medical Treatment Guidelines along with relevant regulatory requirements.

• Draft clear, objective, and timely determinations for reviews.

• Uphold confidentiality and adhere to HIPAA and other applicable privacy regulations.

⛳️ Requirements

• An active, unrestricted RN license is mandatory.

• Preference will be given to candidates with a New York RN license.

• A minimum of three (3) years of experience in areas such as workers' compensation, utilization review, case management, or occupational health is required.

• Familiarity with Workers' Compensation Medical Treatment Guidelines and evidence-based clinical criteria is essential.

• Strong skills in clinical assessment, critical thinking, and written communication are necessary.

• Prior experience in reviewing medical records and making determinations on medical necessity is preferred.

• A reliable high-speed internet/Wi-Fi connection is required.

• A secure home office environment that can safeguard confidential information is essential.

• Proficiency in using web-based review platforms and Microsoft Office applications is required.

• Candidates must complete the electronic credentialing application and obtain organizational approval before conducting a case review.

• A conflict of interest attestation must be completed upon credentialing and prior to performing a case review.

• Active hospital medical staff privileges may be necessary, as applicable.

• It is essential to promptly inform the organization of any adverse changes in licensure or certification status, including board certification status.

🏝️ Benefits

• Utilize clinical expertise to enhance the quality of care provided to patients.

• Become part of a network of esteemed experts in your specialty.

• Receive competitive compensation based on credentials and specialty type.

• Enjoy the flexibility of working remotely from the comfort of your home or office.

• Contribute to maintaining the integrity of the nursing profession and the standards of care.