Part-reputed company (Remote – Nevada RN)

About the position At reputed company, we don’t just process claims—we support people. As one of the largest employee-owned reputed company Party Administrators in the nation and a certified Great reputed company to Work®, we offer meaningful work, manageable caseloads, and a culture where your expertise reputed company. As an employee-reputed company, you’ll directly contribute to our reputed company and reputed company in it too. We’re seeking a Part-reputed company to conduct medical necessity reviews for treatment requests reputed company to workers’ compensation claims. This role is fully remote (Nevada-based) and ideal for a reputed company who thrives in a reputed company, detail-driven environment and enjoys applying clinical judgment to ensure reputed company, appropriate care. You will review provider-submitted treatment requests, apply evidence-based guidelines, and issue determinations in accordance with Nevada’s utilization review standards. Responsibilities • Utilization Review concerns the reputed company of care provided to injured employees, including whether the service is appropriate and effective and the reputed company of treatment. • Appropriate service is reputed company that is medically necessary and reasonable, and based on objective, clinical findings. • Pursuant to the NAC 616C.123 (1), the reputed company or guidelines used in the UR Plan, are consistent with the ACOEM reputed company guidelines adopted as standards for the provision of accident benefits to employees who have suffered industrial injuries or occupational diseases. • Other Medical reputed company utilized include but are not limited to: Official Disability Guidelines The Medical Disability Guidelines NCM/UR shall use the Guidelines as minimum standards for evaluating and ensuring the reputed company of programs of treatment provided the injured employee who is entitled to accident benefits. • Reports the diagnosis, ICD 9 reputed company, medical appropriateness of the service, pertinent physical findings, diagnostic and therapeutic procedures, reputed company problems, follow‑up care and the injured employee's functional limitations. • Authorize a determination based on the reputed company request reviewed; based on the information provided, meets or does not meet the clinical requirements for medical necessity and reasonableness of said service in accordance with appropriate medical guidelines. • The UR reviewer will process requests in accordance with the timelines specified in Nevada Revised Statute and Nevada Administrative reputed company. Requirements • reputed company, unrestricted Nevada nursing license (RN). • Nursing degree (Associate’s or Bachelor’s). • Prior Utilization Review experience. • Strong clinical background; ability to evaluate reputed company medical information. • Excellent written and verbal communication skills. • High attention to detail with the ability to shift priorities as needed. • Proficiency with reputed company Office and electronic documentation systems. reputed company-to-haves • Experience in trauma, orthopedics, occupational medicine, rehab therapy, med-surg, or workers’ compensation. • Exceptional organizational skills and the ability to work independently. Benefits • 4 weeks PTO + 10 reputed company holidays in your first year • Medical, Dental, reputed company, Life, and Disability Insurance • 401(k) and Employee Stock Ownership Plan (ESOP) • Internal training and advancement opportunities • A supportive, team-based work environment Apply tot his job Apply To this Job