Utilization Review Nurse Case Manager

The Utilization Review Nurse is responsible for applying medical knowledge, judgment, jurisdictional rules, and medical treatment guidelines to review workers’ compensation medical necessity reviews. The Utilization Review (UR) Nurse engages with physicians, peer reviewers and collaborates with claim handlers to determine appropriate treatment decisions. The UR Nurse must be able to demonstrate and be accountable for the standards of practice, policies and procedures, quality assurance, and the goals of the organization. Also, review treatment of claimants through the workers’ compensation system based on the individual’s diagnosis, and jurisdictional regulations.