The Hartford Initial Clinical Reviewer - Utilization Management in SYRACUSE, New York
Title: Initial Clinical Reviewer - Utilization Management
Location: United States-New York-Syracuse
Job Number: 1700265
· The Initial Clinical Reviewer is responsible for evaluation of health care services, provided under the Workers Compensation plan, for medical necessity, ensuring that the quality for such care and services meets or exceeds medically accepted standards.
· The Initial Clinical Reviewer will conduct first level prospective, concurrent, and retrospective reviews to evaluate health care services for medical necessity and appropriateness using evidence-based treatment guidelines and nursing judgment, with referral to a Physician Advisor/Peer Clinical Reviewer as necessary.
· Compliance with URAC Workers' Compensation Utilization Management Standards and Utilization Management Policy and Procedures, as well as compliance with all jurisdictional rules and regulations.
· Maintain injured worker privacy, confidentiality and safety, while promoting patient advocacy and adherence to ethical and legal standards.
· Process utilization review determinations within required jurisdictional and URAC timeframes
· Accurate use of all correspondence within regulatory, URAC and Utilization Review Policy and Procedure requirements
· Demonstrate appropriate network utilization in accordance with regulatory requirements
· Oversight of any delegated tasks
· Bachelor's or higher degree in a health-related field
· Licensure as a Registered Nurse required
· Three (3) years of clinical experience with a focus on orthopedic, neurological, rehabilitation, medical/surgical, or occupational health.
· Workers' Compensation Utilization Management or case management experience a plus
· Professional certification as CCM, CDMS, SRS, CVE, and/or CRRN a plus
· Excellent verbal and written communication skills.
· Superior analytical and critical thinking skills
· Ability to use computer technology to efficiently perform job functions.
· Excellent time management abilities
The Hartford Behaviors:
• Deliver Outcomes - Demonstrate a bias for speed and execution that serves our shareholders and customers.
• Operate as a Team Player - Work together to drive solutions for the good of The Hartford.
• Build Strong Partnerships – Demonstrate integrity and build trust with others.
• Strive for Excellence - Motivate yourself and others to achieve high standards and continuously improve.
WHAT ELSE CAN YOU TELL ME?
This role is an on-site position in our Syracuse, NY office.
Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression
Job: Case Management