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Nurse Utilization Review

Employer
York Risk Services Group
Location
Austin, Texas
Salary
Not Specified
Closing date
Jan 29, 2019

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Category
Claims, Health and Medical
Job Type
Not Specified
Career Level
Not Specified

Job Details

At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. Thats why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.

Job Description

  • Conducts utilization reviews on the referrals received. Gathers, summarizes and reviews all medical documentation related to the requested services, compares request to applicable medical guidelines and completes review determination, referring to physician for final review as needed.

  • Collects medical information from providers, summarizes and enters information into the nurses notes in utilization review system
  • Requests additional medical information/documentation from the provider and adjuster as needed
  • Notifies appropriate parties of decision within the required time frame depending on state jurisdictional requirements
  • Becomes familiar with proper coding of services and diagnoses
  • Becomes proficient in the software used in the department
  • Contributes to the success of the company and its posture toward customer service by understanding and responding to our client's needs
  • Responsible for knowing and following various state jurisdictional requirements as well as URAC standards as applicable
  • Responsible for knowing confidentiality policies and procedures and adhering to them
  • Performs other duties as assigned

Company

For more than 55 years, York has been delivering on our mission of reducing risk and getting people and organizations back to health, work and productivity. We’re committed to recruiting, developing and retaining people who represent our values and who believe in our mission. Our associates come from all walks of life but are single-minded in the pursuit of doing right by those we serve. We want each experience for our clients to be marked by expertise, consistency, and compassion because that’s what sets us apart. And we know for certain that it’s our people who allow us to say, boldly and proudly, that York is behind every good outcome.

Company info
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