Sunday , May 19 2024

Cognizant Openings – UM Nurse Reviewer

Website Cognizant

Job Description:

The WCUM Nurse evaluates the appropriateness and necessity of medical treatment through the Utilization Management review process in order to promote quality, outcome based medical care while providing world-class service to customers in an accurate, efficient and courteous manner.

Job Responsibilities:

  • Adheres to Department of Labor, state and company WCUM timeframe requirements.
  • Performs Workers’ Compensation Utilization Management reviews in accordance with federal and state mandated regulations. Maintains compliance with regulatory changes affecting utilization management.
  • Tracks status of all utilization management reviews in progress.
  • Perform WCUM reviews (prospective/concurrent/retrospective) for inpatient/ outpatient services according to the URAC standards and client requirements and/or policies.
  • Job holder will work with groups of Employees (EEs), and Functional Heads in addition to individuals across a variety of tasks
  • Coordinates physician reviewer referral as needed and follows up timely to obtain and deliver those results.
  • Communicates with claims adjusters and/or providers on requests that needs verification.
  • Reviews WCUM requests for services against established clinical review criteria, referring cases not meeting criteria to a physician reviewer.

Job Requirements:

  • Knowledge of medical terminology, anatomy, physiology and concepts of disease.
  • Must have a Bachelor’s Degree in Nursing with an active and unrestricted license to practice in at least one (1) year of clinical experience is preferred.
  • Knowledge on federal, state, URAC, and client protocols is preferred.
  • Able to multi-task and prioritize assignments.
  • Makes sound clinical decisions in a timely manner.
  • Knowledge of basic ICD-9 or ICD 10, and CPT Coding is preferred.
  • Knowledge of nursing principles, techniques, and procedures for the care of patients.

Job Details:

Company: Cognizant

Vacancy Type: Full Time

Job Location: St. Petersburg, FL , US

Application Deadline: N/A

Apply Here

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