Utilization Review Nurse

Summary of Work The Utilization Review Nurse exists to analyze medical information and proposed treatment plans submitted by providers to determine medical necessity and appropriateness of procedures and services.
This position ensures the utilization review process is compliant with WSI administrative laws and establishes professional rapport with providers and WSI staff.
Additional duties include, but are not limited to: Making appropriate referrals to outside medical vendors Maintaining knowledge of current practice trends Updating and completing fields and records in the claims management system Sending appropriate correspondence to medical providers Providing education to internal and external customers on utilization review policies and procedures Providing support to claims and injury management staff Coordinating reviews and discharge planning with medical case managers Contributing in claims staffings as needed with medical advisors, claims adjusters, medical case managers, and legal staff Maintaining confidentiality Developing and updating utilization review policies and procedures Assisting in ongoing evaluation of utilization review policies and procedures Updating current utilization review guidelines and documenting cost savings for the Utilization Review Department Minimum Qualifications Graduate of an accredited registered nursing program with a Registered Nurse license At least two years of working in a hospital, clinic, rehab, or home health setting as a Registered Nurse Preferred Qualifications Utilization review, discharge planning, quality assurance experience, and/or workers' compensation knowledge is preferred Excellent verbal and written communication skills Ability to work effectively, professionally, and courteously with others both internal and external to the organization About Team ND "Far and away the best prize life offers is the chance to work hard at work worth doing.
" - Theodore Roosevelt More than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota.
At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage.
Our purpose is to empower people, improve lives, and inspire success.
Join us in being legendary.
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485 Application Procedures Apply online and upload the following information: cover letter (addressed to Human Resources), resume, references, and copy of college transcripts (if applicable).
All application materials must be received by the closing date to be considered for the open position.
Background checks will be conducted.
WSI staff will score all applications based on a 100-point scoring and rating system.
Applications should include information that directly addresses how the applicant meets the minimum qualifications and a summary of work.
It is very important to be thorough and detailed in the application materials.
Incomplete sections in the application will not be given credit.
Applicants with disabilities should contact Denise Osmond at 701-328-3849 in advance of applying to discuss any special provisions needed for applying or interviewing.
If you are experiencing technical difficulties with the Application Process or uploading attachments, please contact recruiter@nd.
gov or 701-328-3290.
ND Relay Number 1-800-366-6888.
Equal Opportunity Employer The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex (including sexual orientation and gender identity), genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.
As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.
D.
C.
C.
Sect.
23-12-10.