Cost Review/Utilization Nurse

• →Review medical records, treatment plans, and related documentation to evaluate medical necessity and appropriateness of care.

• →Apply established clinical guidelines when evaluating healthcare services and treatment.

• →Analyze provider claims and medical documentation, including applicable ICD and CPT coding.

• →Conduct Hospital Bill Reviews to evaluate the necessity and appropriateness of treatment.

• →Partner with claims professionals to provide clinical insight and recommendations.

• →Serve as a clinical resource to colleagues without a medical background.

• →Consult with medical professionals when additional medical expertise is necessary.

• →Coordinate external medical reviews when appropriate.

• →Accurately document assessments, findings, and recommendations.

• →Manage multiple reviews and priorities while maintaining accuracy, quality, and compliance.

• A current Registered Nurse (RN), Licensed Practical Nurse (LPN), or Advanced Practice Nurse (APN) license that is active, unencumbered, and in good standing.

• Multistate/compact nursing licensure.

• Strong clinical assessment, analytical, and critical-thinking skills.

• Knowledge of medical terminology, diagnoses, treatment, and healthcare documentation.

• Ability to interpret complex medical information and communicate recommendations clearly.

• Strong written and verbal communication skills.

• Ability to work effectively both independently and collaboratively.

• Strong organization and ability to manage multiple priorities.

Multistate/compact nursing licensure is required for this position. Based on the requirements provided by the hiring team, additional individual state licenses are not required, and there are no additional required certifications such as CCM, CPUR, or URAC-related credentials.

This position requires full-time onsite work for the first six months. After the initial six-month period, the position will transition to a hybrid work arrangement, subject to business needs and applicable workplace requirements.

This is an opportunity to use your nursing background in a role focused on clinical analysis, medical decision support, and collaboration. Your expertise will directly support appropriate care decisions and positive outcomes for injured customers.

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GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.