UR First Level Reviewer
CL - Claims
Estimated Travel Percentage (%):
Health Direct, Inc.
The primary responsibility of this position is to perform Utilization Review of workers' compensation claims, based on review criteria and protocols in accordance with state and regulatory agency compliance. Conduct prospective, concurrent and retrospective reviews to determine medical necessity and appropriateness of requested services. Compare treatment episodes to clinical criteria for certification or referral to medical director. Document utilization decisions in appropriate system data fields focusing on data integrity.
Valid RN or LVN license required with 3 years prior managed care and / or UR experience required. Excellent written and oral skills required. Must have the ability to work in a fast-paced, deadline-driven environment. Proficiency in computer skills and telephone customer service is also required. Work hours for position are 11:00 a.m. - 7:30 p.m. central time.
It has been and will continue to be the policy of American International Group, Inc., its subsidiaries and affiliates to be an Equal Opportunity Employer. We provide equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories.
At AIG, we believe that diversity and inclusion are critical to our future and our mission - creating a foundation for a creative workplace that leads to innovation, growth, and profitability. Through a wide variety of programs and initiatives, we invest in each employee, seeking to ensure that our people are not only respected as individuals, but also truly valued for their unique perspectives