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TPA Utilization Nurse

Location:

CT - Meriden, MA - Chicopee, MA - Woburn, ME - South Portland, NY - Buffalo, NY - Rochester, NY - Syracuse, RI - Warwick

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Why USI?

USI is one of the largest insurance brokerage and consulting firms in the world. Something special is happening here with our more than 8,000 associates across the U.S. and abroad – and we invite you to learn more.

Unrivaled Resources and Support

The USI ONE Advantage® allows USI to deliver unique solutions to our clients. This value proposition provides unmatched growth and opportunity for our associates and, at its core, represents a significant investment in our people.

Unique Employee Programs and Deep Community Engagement

We turn care into action with our award-winning wellness program, college scholarships for associates' children, and financial help in times of need. Our annual community service initiative engages associates in hands-on regional service projects helping hundreds of thousands of people each year.

Industry-Leading Associate Rewards and Recognition

In addition to competitive pay, incentives, and benefits, USI recognizes associates through our Summit Awards program, rewarding excellence in those who build our brand each day.

Committed to a Diverse and Inclusive Work Environment  
USI values diversity and is dedicated to ensuring a fair, diverse, and inclusive work environment for all. Our diversity and inclusion program, "I'm With U," advances these initiatives to champion our team members and the communities we serve.

Nationally Recognized as a Top Insurance Workplace

USI has been recognized as one of:

·        Insurance Business America’s Top Insurance Workplaces, three years in a row (2018-2020).

·        Business Insurance’s 2020 list of Best Places to Work in Insurance.

·        Forbes Best Large Employers in America (2018-2019).

Ranked as one of Forbes Best Large Employers in America (2018-2019).

General Description:  Determine the quality of care provided to injured employees for Third Party Administration (TPA) accounts including whether the medial service/procedure is appropriate and effective. Review appropriateness of the health care service to ensure that is medically necessary and reasonable based on objective, clinical findings.

Responsibilities:

  • Review complex workers compensation medical treatment requests to ensure accordance with evidence based medical treatment guidelines, which are generally recongnized by the national medical community and are scientifically based.
  •  Research claim file in relation to the requested medical treatment while interpreting medical reports/claim summaries and applies appropriate established guidelines to requested treatment.  Refer treatment requests which do not meet guidelines, for peer review and determination.

  • Advocate for the injured worker and claims department, ensuring proposed treatment requests are appropriate for the diagnosis

  • Perform daily tasks within the apporpriate established workflow processes, utilize accepted guidelines, and meets legislative and departmental timeframes.

  • Maintain patient confidentiality in discussions of treatment/disease process and conditions.

  • Routinely contact providers to clarify treatment requests, examination findings as well as obtain additional medical information as needed.

  • Maintain clear, concise, and accurate documentation of requested medical treatments to include clinical findings, treatment guidelines and determinations

  • Act as a medical resource in regards to utilization review to claims support nurse and claims department.
  •  Foster a positive and close working relationship with company staff, including claims staff, medical bill review, case manager, legal and client services.

  •  Communicate effectively with individuals outside the company, including clients, medical providers, and vendors.

Personal and Organizational Skills:

·       Superior written and oral communication skills.

·       Ability to work well in a team environment.

·       Must have strong analytical thinking and problem-solving skills.

·       Strong organizational skills required.

Knowledge, Skills and Abilities:

·       Registered Nurse (RN) from accredited college; bachelors’ degree preferred.  Must have an active state license and is eligible to obtain additional state licenses.

·       Minimum 2 years of clinical or related field experience in acute care, emergency medicine, medical surgery, orthopedic practice or other medical enviroment where experience could be applied to occcupational health.

·       Knowledge of managed care industry practices, including medical case management, utilization review and related legal, regulatory and evidence based medical treatment guidelines.

·       Strong clinical background in orthopedics, neurology or rehabilitation.

·       Highly organized, with ability to manage work involving large client volume and adherence to regulatory time frames.

·       Strong understanding of managed care technology applications.

·       Excellent communication skills, both verbal and written.

Physical Demands:

 Work is performed in a climate controlled office environment with minimal noise and limited to no exposure to chemicals or toxins.  Employees operate office equipment including; telephone - headset, Computer,   computer monitors, keyboard, mouse, copier, scanner and mail machine.  Physical tasks of job include; walking, sitting, standing, bending and typing.

Analysis of Physical Demands:

·       Constantly (over 66% of time) work performed requires employees to use repetitive hand motions such as typing, using a keyboard, and sitting at a desk.

·       Frequently (34%-66% of time) work performed requires employees to handle and grasp things, walk on normal surfaces, stand and bend.

·       Occasionally (1%-33% of time) work performed requires employees to drive to client appointments, have repetitive foot movements, walk on uneven or slippery surfaces to and from work and occasionally reach outward to grab things and bend.

Rarely  (< than 1 hour per week) work performed  requires Lifting/Carrying  items that range from 10-50lbs, pushing/pulling  items that range from 10-50lbs,  twisting/ turning including reaching over shoulder or above head , kneeling or squatting.



USI is committed to providing a full-suite of competitive benefits for our growing population and its diverse needs. We offer a wide range of health, welfare and financial benefits including medical, wellness, dental and vision, 401(k), flexible spending and health savings accounts, short and long-term disability, life insurance and other unique employer-sponsored and voluntary programs. USI also offers a generous paid time off policy, paid family leave benefit as well as paid holiday time.


Job ID:

22512

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Notice to Recruiters and Agencies regarding unsolicited resumes or candidate submissions without prior express written approval.
Resumes submitted or candidates referred to USI Insurance Services by any external recruiter or recruitment agency by any means (including but not limited to via Internet, e-mail, fax, U.S. mail and/or verbal communications) without a properly executed written contract for a specified position by an authorized member of the Talent Acquisition team become the property of USI Insurance Services. The Company will not be responsible for, or owe any fees associated with, referrals of those candidates and/or for submission of any information, including resumes, associated with individuals.

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