Genex Service LLC Utilization Reviewer 2 US--Remote Job ID: 24-16861 Type: Regular Full-Time # of Openings: 1 Category: Insurance & Administration Mitchell International, Inc. Overview

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

Responsibilities

We are seeking a qualified Utilization Reviewer who can work remotely from home. The ideal candidate performs utilization review p

erforming precertification review for New Jersey auto accident PIP medical treatment referrals in our fast-paced, supportive environment while working remotely. Nurses will use critical thinking and solid clinical judgment to ensure appropriate, medically necessary treatment is authorized. Nurses will also escalate treatment requests for Peer Advisor review or Independent Medical Exam (IME) when appropriate, based on insurer DPR plans, Care Paths and clinical judgment.

Clear Registed Nurse (RN) license in New Jersey or a Nurse Licensure Compact state.

Perks: Full and comprehensive benefits programs starting on your first day, 24 days of paid vacation/holidays in your first year plus sick days, Employee Assistance and a Referral Program.

Responsibility

• * Uses solid clinical judgment to ensure treatment approved is medically necessary.
• * Forwards treatment requests for physician reviewer that cannot be approved as medically necessary based on application of solid clinical judgment.
• * Collaborates with healthcare providers, claims adjusters, and other stakeholders to gather relevant information for comprehensive assessments.
• * Evaluates medical documentation to ensure compliance with industry standards and regulatory requirements.
• * Communicates findings clearly and concisely through written reports and verbal discussions.
• * Stays up-to-date on industry regulations, medical advancements, and best practices to enhance the quality of reviews.

• * Participates in team meetings and contributes to the continuous improvement of utilization review processes.

   

   

   

Qualifications

Minimum Education: Associates degree

Required Skills and Experience: 2-3 years of Utilization experience.

Desired Skills and Experience:

New Jersey Decision Point Review (NJ DPR) experience preferred.

Benefits We're committed to supporting your ul Equal Employment Opportunity/M/F/disability/protected veteran status PI240291682