• Conduct utilization reviews and assess medical necessity of treatments.
• Collaborate with healthcare providers to ensure quality patient care.
• Analyze patient records and health plans for compliance.
• Communicate findings and recommendations to stakeholders.
• Stay updated on regulations and healthcare policies.
• Provide education on utilization review processes.

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in nursing (BSN)
• Active unrestricted RN license that can be validated through the PRC website
• 1-2 years of relevant Clinical experience in any medical/surgical department, Orthopedic, Medical/Surgical ICU, Coronary Care Unit (CCU), Rehabilitation, Emergency department
• Written and verbal fluency in English
• Candidate should be willing to work onsite (BGC)
• The candidate should be willing to work in US operation hours

PREFERRED:

• Proficiency in all Microsoft Office products, including Project, Word, Excel, PowerPoint, Visio, and SharePoint
• Knowledge of workers’ compensation laws and regulations, behavioral health, case management practice, URAC standards, ODG, Utilization review, pharmaceuticals to treat pain, pain management process, drug rehabilitation, state workers’ compensation guidelines, periods of disability, and treatment needed
• Leadership/management/motivational skills, as well as analytical and strong organizational skills
• Ability to work in a team environment and to meet or exceed Performance Competencies