Utilization Review Nurse - Dallas, TX

About the position Join our dedicated team at Injury Management Organization, Inc. as a Full-Time Registered Nurse specializing in Utilization Review! Located in Plano, TX, this hybrid position offers an exciting opportunity for RNs with a background in Workers' Compensation to apply their critical thinking skills and independent judgment in evaluating patient care. You'll leverage your expertise in medical terminology and familiarity with CPT/ICD-10 codes to ensure optimal outcomes for our clients while working in a flexible and customer-focused environment. With a competitive salary range of $72,000 to $76,000, this role rewards your dedication and passion for excellence in healthcare. Your contributions will play a vital role in fostering teamwork and stewardship in our organization, where engagement and accountability are paramount. As a team member you'll be able to enjoy benefits such as Medical, Dental, Vision, Life Insurance, Health Savings Account, Competitive Salary, Paid Time Off, Snack/Drink Room, 10 Paid Holidays including birthday, and Matching 401(k) 50% up to 4% of salary. Take the next step in your career and be a part of a forward-thinking team that values your skill set and commitment to innovation. Let us introduce ourselves IMO is a trusted managed care partner for both private and public enterprise with vast experience in quality case management and positive injured employee outcomes. For over three decades our goal has been to provide industry leading customer service to our industry partners and their injured employees â€" a goal that has allowed IMO to grow from Texas into multiple other states including Arkansas, Oklahoma, and New Mexico. As a Utilization Review Registered Nurse at Injury Management Organization, Inc., you will play a crucial role in evaluating medical treatment records for patients with work-related injuries. Your primary responsibility will be to make informed clinical determinations in alignment with ODG criteria, utilizing evidence-based guidelines to establish the medical necessity of services requiring preauthorization. You will process requests from healthcare providers and injured employees, ensuring compliance with Texas Department of Insurance Rule 134.600 and 137.100. This vital function allows you to employ your skills in medical terminology and critical thinking while maintaining a focus on exceptional patient care, all within a supportive and innovative team environment. To excel as a Utilization Review Registered Nurse at Injury Management Organization, Inc., you must possess exceptional interpersonal and communication skills, enabling effective coordination of reviews with physicians across various specialties. Familiarity with standard evidence-based practice guidelines and best treatment practices is essential, as you will assess the medical necessity of services for injured employees. Your role will require you to compile, process, and maintain medical records meticulously, adhering to the ethical, legal, and regulatory requirements of the healthcare system. Proficiency in utilizing relevant software and tools is crucial for streamlining the review process and ensuring accurate documentation. Additionally, strong critical thinking skills and independent judgment will empower you to make sound clinical determinations that align with both organizational goals and patient care standards.

Responsibilities

• Evaluate medical treatment records for patients with work-related injuries.
• Make informed clinical determinations in alignment with ODG criteria.
• Utilize evidence-based guidelines to establish the medical necessity of services requiring preauthorization.
• Process requests from healthcare providers and injured employees.
• Ensure compliance with Texas Department of Insurance Rule 134.600 and 137.100.
• Coordinate reviews with physicians across various specialties.
• Assess the medical necessity of services for injured employees.
• Compile, process, and maintain medical records meticulously.
• Adhere to the ethical, legal, and regulatory requirements of the healthcare system.
• Streamline the review process and ensure accurate documentation using relevant software and tools.

Requirements

• Must have and maintain a valid RN license in accordance with the Texas Board of Nursing
• At least 3 years' experience working in the area of Workers' Compensation which may include Case Management, Orthopedic nursing, and/or Utilization Review experience
• Knowledge of CPT/ICD-10 codes and medical terminology
• Excellent computer/technology skills
• Exceptional interpersonal and communication skills
• Familiarity with standard evidence-based practice guidelines and best treatment practices
• Strong critical thinking skills and independent judgment

Nice-to-haves

• Bilingual English/Spanish
• Maintain current knowledge and requirements as related to Texas Workers' Compensation rules

Benefits

• Medical
• Dental
• Vision
• Life Insurance
• Health Savings Account
• Competitive Salary
• Paid Time Off
• Snack/Drink Room
• 10 Paid Holidays including birthday
• Matching 401(k) 50% up to 4% of salary

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