WCF Insurance

Utilization Review Nurse

Posted on Sep 9 Sandy, UT


The Utilization Review department has an immediate opening for someone who can demonstrate the WCF values to join their team as a Utilization Review Nurse. This is a full-time exempt position based in WCF's Sandy, Utah headquarters.

Responsibilities


The Utilization Review Nurse reviews proposed treatment and services for medical necessity, appropriateness, and efficiency to ensure that injured workers receive quality medical care. The person in this position determines medical necessity by analyzing information submitted by adjusters and medical providers and then applying medical policies, practices, and clinical knowledge to make case determinations and appropriate referrals. The Utilization Review Nurse also negotiates costs of medical services with providers.

Qualifications


  • A current RN license with two years of clinical experience or a current LPN license with four years of clinical experience;
  • Utilization review, discharge planning, quality assurance, or case management experience preferred;
  • Understanding of workers' compensation preferred;
  • Excellent written and oral communication skills;
  • Strong critical thinking, analytical, and research skills.

Internal candidates must have acceptable job performance, a good attendance record, and must notify their current supervisor that they have applied for the position.