You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a Utilization Review Nurse responsible for reviewing requested medical treatment under Massachusetts workers’ compensation claims. The primary goal is to determine medical necessity and quality of care by evaluating treatment plans and medical documentation against state-mandated treatment guidelines and established clinical guidelines.
Key Responsibilities
- Conduct state-mandated utilization reviews to determine medical necessity and quality of care.
- Review treatment plans against applicable guidelines from Massachusetts, ODG, Colorado, and Rhode Island.
- Analyze medical records and summarize clinical findings to support utilization review determinations.
- Approve medically necessary services that ensure quality patient care.
- Assist with complex treatment authorization requests, applying clinical guidelines consistently.
- Maintain accurate documentation of all review activities and decisions.
Qualifications
- Active RN License in New Hampshire.
- Minimum of 2-3 years of clinical nursing experience.
- Strong computer literacy and ability to navigate different electronic systems.
- Prior Utilization Review experience in Workers' Compensation is preferred.
- Background in home health/home care or Med/Surg is preferred.
Additional Requirements
Work from home on Mondays and Tuesdays; in office from Wednesday to Friday in Manchester.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
Our client emphasizes a supportive, hands-on management style with great work-life balance and provides equipment necessary for both home and office work environments.*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
Any required state or Joint Commission training is compensated at the state or local minimum wage rate.
*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
