Mitchell International, Inc.

Nurse Reviewer, Utilization 3

US-CA
Job ID
17-7862
Type
Regular Part-Time

Company Overview

Mitchell International, Inc. is a leading provider of information and workflow solutions to the Property & Casualty Claims Industry and their supply chain partners. We solve interesting and complex problems that directly affect the customers our clients serve. We are constantly adapting to stay on the forefront of emerging technologies and we work diligently to maintain our position as a thought leader within our industry.

 

Mitchells workers compensation national managed care program offers solutions for insurance carriers, third-party administrators and employers. We recommend an integrated suite of solutions that include utilization review and case management with a focus on managing total claims costs while expediting safe return to work.

 

 

Job Description

ACS (third party)

 

As a Nurse Reviewer with Mitchell you will perform utilization review on various Third Party auto insurance related retrospective treatment referrals.  You will read complete medical claim files and construct a summarization and analysis of the treatment rendered to the injured party. You will communicate with claims adjusters at times and bill review team members to ensure adequate application of any appropriate guidelines and reviews decisions. You will apply nursing knowledge and utilize medical review criteria and solid clinical judgment to ensure treatment approved is medically necessary. You will also act as a point of contact for escalated customer concerns.  

Qualifications

 

 

ACS (third party)

  • Knowledge: You are a seasoned, experienced professional with a full understanding of utilization review. You will work one case at a time with approximately 23-30 cases a month. A clinical background related to trauma, orthopedic, physical and rehabilitation nursing is a plus.
  • Experience: Mitchell’s Nurse Reviewers are Registered Nurses and will typically have at least 3 years clinical experience and one year within utilization review.
  • Written Abilities:  Proficient grammar, sentence structure and written communication skills required.
  • Licenses or Certifications: You must be a registered nurse (RN). Having certifications within Legal Nurse Consulting and CPC are a plus.

*Requires DSL, fiber or cable internet connection from home. 1 mbps preferred or better.*

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