Sr Supplier Medical Process Specialist (Nurse Utilization Review)

　　110387

　　We are currently seeking a Registered Nurse to join the Zurich Utilization Review Program. We are open to hiring talent in one of the following locations: Illinois, California, Texas, New Jersey, Georgia, Kansas.

　　The Zurich Utilization Review process provides medical necessity reviews for requests related to Workers Compensation claims to help mitigate total loss costs for our customers. The U.S. healthcare spend is on the rise and medical costs are often a primary contributor to the overall claims cost. The dedicated professionals on Zurich’s Utilization Review Governance Team bring a wealth of knowledge, skills and experience from various medical disciplines to uphold and provide a rigorous Utilization Review workflow that delivers on Zurich North America’s customer-led philosophy and Claims strategy.

　　As a Nurse on this team, you will serve as a team member and point of contact to our workers’ compensation Utilization Review Supplier. An immediate key initiative will be to partner on a cross- functional team to develop criteria and a process workflow for the appropriate review, determination of medical treatment as part of a workers’ compensation claim. Travel minimal.

　　Primary Accountabilities include:

　　Respond and resolve complex medical management inquiries and issue escalations professionally and promptly.

　　Review processes, identify opportunities, and plan transactional, workflow or systems solutions as part of continuous improvement and training efforts.

　　Plan and perform data and quality reviews related to vendor performance to identify, assess, and take action to mitigate risks and ensure compliance to governance controls.

　　Manage supplier performance to facilitate alignment with service level agreements by reporting and analyzing operational results and identifying trends and issues.

　　Basic Qualifications:

　　Associates degree and 3 or more years of experience in the Nursing areaAND

　　Licensed registered nurse in state of residence

　　3 or more years of clinical experience

　　Experience with Microsoft Office

　　Experience leading operational initiatives and/or work streams

　　Preferred Qualifications:

　　Bachelor’s Degree in nursing and 3 more years of experience in the nursing area

　　Experience in a transactional, operational or customer service environment

　　Quality auditing experience

　　Knowledge of URAC Standards

　　Knowledge of the insurance industry and regulatory environment

　　Experience collaborating across work groups and/or companies

　　Compensation for roles at Zurich varies depending on a wide array of factors including but not limited to the specific office location, role, skill set, and level of experience. As required by local law, Zurich provides in good faith a reasonable range of compensation for roles. For additional information about our Total Rewards, click here (https://www.zurichna.com/careers/benefits) . Other rewards may include short term incentive bonuses and merit increases. Candidates with salary expectations outside of the range are encouraged to apply, and will be considered based on experience, skill, and education. The salary provided is a nationwide market range and has not been adjusted for the applicable geographic differential associated with the location where the position may be filled. The starting salary range for this position is $63,300.00 - $103,700.00.

　　As a condition of employment at Zurich, employees must adhere to any COVID-related health and safety protocols in place at that time ( https://www.zurichna.com/careers/faq ).

　　A future with Zurich. What can go right when you apply at Zurich?

　　Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please clickhere (https://www.zurichna.com/careers) to learn more.

　　As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet

　　Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.

　　Location(s): AM - Illinois Virtual Office, AM - California Virtual Office, AM - Georgia Virtual Office, AM - Kansas Virtual Office, AM - New Jersey Virtual Office, AM - Texas Virtual Office

　　Remote Working: No

　　Schedule: Full Time

　　Employment Sponsorship Offered: No

　　Linkedin Recruiter Tag: #LI-LC1 #LI-ASSOCIATE #LI-HYBRID