Remote Utilization Review Clinician (RN/OT/PT)

EK Health Services Inc.; Salt Lake City (UT); À distance; USD 41 000 - 48 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision insurance

401K

Paid Time Off

Paid Holidays

Internet stipend

Résumé du poste

EK Health Services Inc. is hiring for a Utilization Review (UR) Health Care Professional in a remote-capable role. The position emphasizes clinical knowledge in utilization management to assess medical necessity, applying jurisdiction-specific evidence-based guidelines.

This role supports coordination among providers, insurers, claimants, and other stakeholders. Responsibilities include data collection, evaluation, planning, and communication of decisions, with a focus on compliant, quality

Qualifications

• Graduate of an accredited school of nursing, chiropractic, or another related medical program.
• Valid state-specific license in the appropriate scope of practice in good standing with no restrictions.
• Experience in UR, Workers' Compensation experience highly preferred, but not required.
• Excellent Written and Oral Communication Skills

Responsabilités

• Perform a complete evaluation of the medical data for the request.
• Collect additional relevant data as needed to decide on medical necessity.
• Analyze the collected data to determine medical necessity as per evidence-based guidelines.
• Discuss the analyzed data and the comprehensive plan of care with the insurance representative prior to implementation as needed.
• Upon determination, provide notification of decision to provider, requester, claimant, carrier, and all other parties as mandated by law.
• Coordinates information between all parties (injured worker, physicians, employer, other providers, such as therapists, and attorney, if any are involved).
• Participate in annual audits of work product to ensure compliance.

Connaissances

Communication skills

Interpersonal skills

Organization skills

Computer literacy

Formation

Graduate of an accredited nursing/medical program

Outils

MS Word

MS Excel

Email

Description du poste

EK Health Services Inc. is hiring for a Utilization Review (UR) Health Care Professional in a remote-capable role. The position emphasizes clinical knowledge in utilization management to assess medical necessity, applying jurisdiction-specific evidence-based guidelines.

This role supports coordination among providers, insurers, claimants, and other stakeholders. Responsibilities include data collection, evaluation, planning, and communication of decisions, with a focus on compliant, quality