Nurse Reviewer - Pa (Hybrid)

Job Details
Job Location
Pennsylvania Remote - Remote, PA
Position Type
Full Time
Salary Range
$68,000.00 - $80,000.00 Salary
Travel Percentage
None
Job Category
Health Care
Description
Medata, a company known for innovation and technology in the Risk Management Industry is seeking a UR Nurse Reviewer to join our talented team. This seasoned UR Nurse Reviewer may work from home from PA. We pride ourselves in experience, leadership and the commitment of offering solutions to meet today's needs and tomorrow's demands. If you are looking to work with a dedicated UR Team and want to work with the best in the industry, this position is for you.
**Please note that this is a In-office position.
Location - King Of Prussia,PA
Job Purpose:
Review Workers Compensation requests submitted by the provider, requestor, claimant or carrier to determine the medical necessity of the treatment utilizing clinical expertise and evidence-based treatment guidelines.
Duties:

• Perform an evaluation of the medical data for utilization review requests.
• Confirm accurate completion of data intake.
• Collect additional relevant data as needed with regard to determining medical necessity.
• Analyze the collected data to apply evidence-based guidelines.
• Review requests and make certification decisions, when appropriate, or prepare a case for peer review referral.
• Coordinates information between all parties (injured worker, physicians, employer, therapists, attorney, etc)
• Participate in audits of work product to insure compliance.
• Monitor daily processing inventory, including rush/urgent requests.
• Provide inventory information and raise concerns to clinical director.
• Complete production logging.
• Assist leadership team with training and coordinating back-up resources.

Qualifications
Requirements/Skills/Qualifications:

• Graduate of an accredited school
• Valid current RN license in good standing
• Able to perform the professional and technical skills of a Registered Nurse
• Minimum 2 years of direct patient care
• Excellent, written and oral communication skills
• Ability to read and interpret medical reports and treatment guidelines
• Must be able to maintain confidentiality
• Must possess strong personal organizational skills
• Must have experience and knowledge of intermediate computer skills
• Ability to work independently with little to no supervision
• Ability to work in a fast-paced and time-sensitive environment
• Ability to meet deadlines in a production driven environment
• Ability to work with WORD and EXCEL documents.
• This is a PA Hybrid Position.

Preferences:

• Experience in Utilization Review, Workers Compensation is a plus