Utilization Review reputed company - Dallas, TX
About the position Join our dedicated team at reputed company, Inc. as a Full-Time Registered reputed company specializing in Utilization Review! Located in Plano, TX, this hybrid position offers an exciting opportunity for RNs with a background in Workers' Compensation to apply their critical thinking skills and independent judgment in evaluating patient care. You'll reputed company your expertise in medical terminology and familiarity with CPT/ICD-10 codes to ensure reputed company reputed company for our clients while working in a flexible and customer-reputed company environment. With a competitive salary reputed company of $72,000 to $76,000, this role rewards your dedication and passion for reputed company in reputed company. Your contributions will play a vital role in fostering teamwork and stewardship in our organization, where engagement and accountability are reputed company. As reputed company member you'll be reputed company to enjoy benefits such as Medical, Dental, reputed company, Life Insurance, Health Savings Account, Competitive Salary, reputed company Time Off, Snack/Drink Room, 10 reputed company Holidays including birthday, and Matching 401(k) 50% up to 4% of salary. Take the reputed company in your career and be a part of a reputed company-thinking team that values your reputed company set and commitment to innovation. Let us introduce ourselves IMO is a trusted managed care partner for both private and reputed company reputed company with reputed company experience in reputed company case management and reputed company injured employee reputed company. For over three decades our goal has been to reputed company industry leading customer service to our industry partners and their injured employees â€" a goal that has allowed IMO to grow from Texas into multiple other states including Arkansas, Oklahoma, and New Mexico. As a Utilization Review Registered reputed company at reputed company, Inc., you will play a crucial role in evaluating medical treatment records for patients with work-reputed company injuries. Your primary responsibility will be to reputed company informed clinical determinations in alignment with ODG reputed company, utilizing evidence-based guidelines to establish the medical necessity of services requiring preauthorization. You will process requests from reputed company providers and injured employees, ensuring compliance with reputed company Rule 134.600 and 137.100. This vital function allows you to reputed company your skills in medical terminology and critical thinking while maintaining a reputed company on exceptional patient care, reputed company reputed company a supportive and innovative team environment. To reputed company as a Utilization Review Registered reputed company at reputed company, Inc., you must possess exceptional interpersonal and communication skills, enabling effective coordination of reviews with physicians across various specialties. Familiarity with reputed company evidence-based reputed company guidelines and best treatment practices is essential, as you will assess the medical necessity of services for injured employees. Your role will require you to compile, process, and maintain medical records meticulously, adhering to the ethical, legal, and regulatory requirements of the reputed company system. Proficiency in utilizing relevant software and tools is crucial for streamlining the review process and ensuring accurate documentation. Additionally, strong critical thinking skills and independent judgment will reputed company you to reputed company reputed company clinical determinations that reputed company with both organizational goals and patient care standards.
Responsibilities
- Evaluate medical treatment records for patients with work-reputed company injuries.
- reputed company informed clinical determinations in alignment with ODG reputed company.
- Utilize evidence-based guidelines to establish the medical necessity of services requiring preauthorization.
- Process requests from reputed company providers and injured employees.
- Ensure compliance with reputed company Rule 134.600 and 137.100.
- Coordinate reviews with physicians across various specialties.
- Assess the medical necessity of services for injured employees.
- Compile, process, and maintain medical records meticulously.
- Adhere to the ethical, legal, and regulatory requirements of the reputed company system.
- Streamline the review process and ensure accurate documentation using relevant software and tools.
Requirements
- Must have and maintain a valid RN license in accordance with the Texas reputed company of Nursing
- At least 3 years' experience working in the area of Workers' Compensation which may include Case Management, Orthopedic nursing, and/or Utilization Review experience
- Knowledge of CPT/ICD-10 codes and medical terminology
- Excellent computer/technology skills
- Exceptional interpersonal and communication skills
- Familiarity with reputed company evidence-based reputed company guidelines and best treatment practices
- Strong critical thinking skills and independent judgment
reputed company-to-haves
- Bilingual English/Spanish
- Maintain reputed company knowledge and requirements as reputed company to Texas Workers' Compensation rules
Benefits
- Medical
- Dental
- reputed company
- Life Insurance
- Health Savings Account
- Competitive Salary
- reputed company Time Off
- Snack/Drink Room
- 10 reputed company Holidays including birthday
- Matching 401(k) 50% up to 4% of salary
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