Utilization Review Nurse - Manchester, United States - Windham Group

Description

Position Title:
Utilization Review Nurse - Workers' Compensation

Hours: 40 hours/week. This is a salaried, exempt position.

Location:
Manchester, NH

Overview
Windham Group's mission is to return injured workers to health while maintaining productivity at their original jobs. Our Credo, _"To work is to be needed, and to be needed is essential for life"_is what drives us.

We work as a team to integrate expertise at every level of recovery to restore the health, well-being and livelihood to the injured and disabled, thereby reducing the financial and human costs of work related injuries.

Due to consistent growth, Windham Group is seeking a full time
Utilization Review Nurse in our Manchester, NH office.


Job Description - Utilization Review Nurse
This is a full-time position that reviews requested medical treatment, matches it to guidelines mandated by the DIA OHP, and comes to a decision regarding medical necessity


Essential Duties and Responsibilities

• Perform state mandated utilization review (review of medical care) and makes decisions regarding medical necessity and quality of care based on state guidelines.
• Review medical documentation and summarize findings by following regulations and outlined procedures
• Approve medically necessary services to promote quality care. Assist in determination of medically complicated treatment authorization requests. Review, document and summarize findings.

Requirements:

• Knowledge of professional nursing principles and techniques, medical terminology; hospital routine and equipment; and medicines and narcotics
• Position requires extensive computer use requiring computer knowledge in MS Outlook, Word and Adobe.
• Critical thinking
• Strong communication skills both verbal and written.
• Demonstrate strong assessment skills and attention to detail
• Must be able to demonstrate team behavior and must be willing to promote a teamoriented environment
• Ability to multitask
• Time management skills
• Ability to work independently
• Utilization Review experience, preferably with workers comp
• Graduate of an accredited school of nursing.
• RN, with a Bachelors degree in a health related field a plus
• Three years of professional nursing
• Experience in an institution licensed for inpatient care
• Current license as a Registered Nurse in the state of New Hampshire
• MUST have excellent computer skills

Reports to:
Director of Utilization Review


Salary Structure:
Commensurate with experience and qualifications


Benefits:

• 401(k)
• 401(k)

matching

• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Education:

• Associate (preferred)

Experience:

• Utilization review: 1 year (preferred)

Workers Compensation: 1 year (preferred)


License/Certification:

• RN (preferred)

Work Location:
In person