Mitchell International, Inc.

  • Supervisor 2, Nurse Utilization Reviewer

    Job Location US-MO
    Job ID
    18-8370
    Type
    Regular Hire
  • 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.

     

    Mitchell’s worker’s 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

    **This position it located remotely, anywhere in the US**

     

    As a Supervisor, Nurse Utilization Reviewer, you would provide oversight and guidance to the clinical Managed Care team. This includes monitoring incoming assignment volumes and facilitating productivity within service level expectations. You would also provide back up support to the clinical team to meet operational needs in addition to assessing operational measures and outcomes to identify areas of improvement.  

     

    Responsibilities:

    • Reviews requested treatment/procedures within Mitchell utilization review policies, URAC time frames or state-mandated timeframes (whichever is more restrictive) for determination of medical necessity and appropriateness.
    • Uses evidence-based, nationally recognized treatment protocols and accesses physician reviewers, as indicated, when certification/approval cannot be recommended based upon medical review criteria or clinical experience.
    • Facilitates communication of quality determinations verbally and/or in writing with required parties in accordance with Mitchell International policies and procedures.
    • Provides leadership, oversight and guidance to team members to ensure quality product for customers.
    • Maintains ongoing communication with the claims examiner/adjustor as to status of determination.
    • Acts as a clinical resource to non-clinical staff.
    • Stays abreast and complies with state/federal legislation as it applies to utilization management services.
    • Understands and complies with applicable URAC workers’ compensation utilization management standards.
    • Stays abreast of healthcare industry current practices and trends. 

    Qualifications

     

    • Current, unrestricted RN, LPN, or LVN license required.
    • 5 or more years’ experience in utilization review in workers' compensation and/or medical cost containment required.
    • Minimum of 2 year's prior leadership experience.
    • Must be able to motivate team using positive feedback and unity to achieve the highest quality results and outstanding customer service.
    • Knowledge and understanding of the property/casualty insurance industry and healthcare delivery system preferred.
    • Provide strategic leadership and direction for the delivery of services to clients/customers and team members.
    • Perform training needed to deliver service improvements and enhance customer experience.
    • Maintain regular communication with clinical team members to provide productivity and quality statistics and obtain feedback on operational functions.
    • Act as a clinical resource to non-clinical staff.
    • Stays abreast and complies with state/federal legislation as it applies to utilization management services. Understands and complies with applicable URAC workers’ compensation utilization management standards.
    • Must be computer proficient with hardwired home office station including DSL, fiber or cable internet connection.

     

     

    Mitchell International, an equal opportunity employer, values the diversity of our workforce and the knowledge of our people.  Mitchell will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

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