USI Holdings Corporation

TPA Utilization RN

USI Holdings Corporation • $75K — $100K *
Norwalk, CT 06854In-Person
Healthcare
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Registered Nurse (RN) with an active state license; bachelor's degree preferred.
  • 2+ years of clinical or relevant experience in acute care or related fields.
  • Knowledge of managed care practices and legal/medical guidelines.
  • Strong clinical expertise in orthopedics, neurology, or rehabilitation.
  • Proficient in managed care technology applications.

Responsibilities

  • Review complex workers' compensation medical treatment requests for compliance with evidence-based guidelines.
  • Research claim files and interpret medical reports to evaluate treatment requests.
  • Advocate for injured workers to ensure appropriate treatments aligned with diagnoses.
  • Follow established workflow processes and regulatory timelines for case review.
  • Maintain patient confidentiality in all communications and documentation.
  • Communicate with healthcare providers to clarify treatment requests and obtain information.
  • Document treatments, clinical findings, and decisions accurately.

Benefits

  • Opportunities for professional development and additional licensing support.
  • Collaborative work environment fostering strong interdepartmental relationships.
  • Engagement in a robust case advocacy role supporting injured workers.
  • Access to managed care technology tools for efficiency.
Full Job Description
Description and Requirements

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.


#LI-NM2

$75k-$100k

About USI Holdings Corporation

USI is a leading insurance brokerage and consulting firm, delivering property and casualty, employee benefits, personal risk, program and retirement solutions throughout the United States. Headquartered in Valhalla, New York, USI has over 200 offices across the United States. USI combines industry-leading national capabilities delivered through longstanding, passionate and committed local service teams. USI stands for Understand, Service and Innovate. At USI, we work to Understand the specific needs of our clients, to provide an unparalleled local Service experience, and to Innovate with cutting-edge solutions so our clients can continue to invest and grow.
Learn more about USI Holdings Corporation
Size
4,800 employees
Industry
Finance & Insurance
Founded
1994
* Ladders Estimates

Similar Jobs

Ad banner background

Get Ready For Your
Next Interview

More Jobs at USI Holdings Corporation

  • USI Holdings Corporation
    TPA Utilization RN
    $75K — $100K *
    Norwalk, CT 06854 (Western Ct County)
    Today
    Healthcare
    In-Person
  • USI Holdings Corporation
    TPA Utilization RN
    $75K — $100K *
    Warwick, RI 02886 (Kent County)
    Today
    Healthcare
    In-Person
  • USI Holdings Corporation
    TPA Utilization RN
    $75K — $100K *
    Syracuse, NY 13210 (Onondaga County)
    Today
    Healthcare
    In-Person
  • USI Holdings Corporation
    TPA Utilization RN
    $75K — $100K *
    Needham, MA 02492 (Norfolk County)
    Today
    Healthcare
    In-Person
  • USI Holdings Corporation
    TPA Utilization RN
    $75K — $100K *
    Woburn, MA 01801 (Middlesex County)
    Today
    Healthcare
    In-Person

More Healthcare Jobs

Find similar TPA Utilization RN jobs:

NationwideNorwalk, CT