Utilization Review Rn Jobs in Boston, MA (NOW HIRING)

We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections. This includes reviewing records, preparing the narrative and an appropriate allocation for medical treatment and prescription medications. Candidates will demonstrate knowledge of CMS policies related to preparing MSAs. Strong writing skills, analysis skills and application of guidelines are required for this position. Medical Analysts will work closely with our attorneys and other members of the medical team to prepare Medicare Set-Asides and Medical Cost Projections. 

For over 50 years, Verisk has been the leading data analytics and technology partner to the global insurance industry by delivering value to our clients through expertise and scale. We empower communities and businesses to make better decisions on risk, faster.

At Verisk, you'll have the chance to use your voice and build a rewarding career that's as unique as you are, with work flexibility and the support, coaching, and training you need to succeed. 

For the eighth consecutive year, Verisk is proudly recognized as a Great Place to Work for outstanding workplace culture in the US, the fourth consecutive year in the UK, Spain, and India, and the second consecutive year in Poland. In addition, we've been recognized by The Wall Street Journal as one of the Best-Managed Companies and by Forbes as a World's Best Employer, testaments to the value we place on workplace culture.

We're 7,000 people strong.  We relentlessly and ethically pursue innovation. And we are looking for people like you to help us translate big data into big ideas. Join us and create an exceptional experience for yourself and a better tomorrow for future generations.

 Verisk Businesses

Underwriting Solutions - provides underwriting and rating solutions for auto and property, general liability, and excess and surplus to assess and price risk with speed and precision

Claims Solutions - supports end-to-end claims handling with analytic and automation tools that streamline workflow, improve claims management, and support better customer experiences

Property Estimating Solutions - offers property estimation software and tools for professionals in estimating all phases of building and repair to make day-to-day workflows the most efficient

Specialty Business Solutions - provides an integrated suite of software for full end-to-end management of insurance and reinsurance business, helping companies manage their businesses through efficiency, flexibility, and data governance

Catastrophe and Risk Solutions - provides risk modeling solutions to help individuals, businesses, and society become more resilient to catastrophic events.

Marketing Solutions - delivers data and insights to improve the reach, timing,relevance, and compliance of every consumer engagement

Life Insurance Solutions - offers end-to-end, data insight-driven core capabilities for carriers, distribution, and direct customers across the entire policy lifecycle of life and annuities for both individual and group.

Verisk Maplecroft - provides intelligence on sustainability, resilience, and ESG, helping people, business, and societies become stronger

Verisk Analytics is an equal opportunity employer.

Verisk invests in a benefits package for all employees that includes the following: Health Insurance, a Retirement Plan, Disability benefits, and a Paid Time Off program. We offer a competitive total rewards package that includes base salary determined based on role, experience, skill set, and location.

All members of the Verisk Analytics family of companies are equal opportunity employers. We consider all qualified applicants for employment without regard to race, religion, color, national origin, citizenship, sex, gender identity and/or expression, sexual orientation, veteran's status, age or disability. Verisk's minimum hiring age is 18 except in countries with a higher age limit subject to applicable law.

https://www.verisk.com/company/careers/

Unsolicited resumes sent to Verisk, including unsolicited resumes sent to a Verisk business mailing address, fax machine or email address, or directly to Verisk employees, will be considered Verisk property. Verisk will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume.

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About You and How You Can Excel in This Role 

• Bachelor's Degree, Associate Degree or Diploma in Nursing required 
• 3-5 years' experience in Nursing preferred 
• Registered Nurse (RN) license in good standing with applicable Board of Nursing required 
• Experience in preparing medical review reports, medical bill reviews and utilization reviews in injury cases preferred 
• Certification in any of the following preferred: Medicare Set-aside Certified Consultant (MSCC), Life Care Planner (CLCP or CNLCP), Certified Case Manager (CCM), Medical Coding, Legal Nurse Consulting, Rehabilitation Counseling, Disability Management, Utilization Review 
• Strong interpersonal, oral, and written communication skills including report preparation preferred 
• Ability to work effectively both independently and as a member of a team 
• Ability to gather data, compile and synthesize information, including medical information, claims payment histories and billing, to identify level and types of services utilization

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About the Day to Day Responsibilities of the Role 

• Through a review of relevant medical files and related documentation, provides a narrative and cost projection for future treatment related to Workers Compensation and Liability injuries consistent with the current guidelines 
• Collaborates with a team of attorneys and medical professionals in identifying negotiating and documenting guidelines and cost reductions on future treatment plans 
• Uses ISO Claims Partners proprietary information technology tools to identify diagnoses, treatment guidelines, and prescription medication pricing, and documents the case when applicable 
• Provides additional analysis and medical recommendations as needed 
• Identifies cost drivers and cost savings opportunities on all files and completes client specific -cost mitigation activities on files where applicable 
• This is a full-time position, but additional hours may be required during peak time 
• Occasional travel (<10% of the time)