Remote Utilization Review Clinician (RN/OT/PT)

Wellsky; Tulsa (OK); Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Excellent medical benefits

Mental Health support (EAP)

Paid time off + 13 holidays

100% vested 401(k)

Educational assistance

Job summary

WellSky offers a fully remote Utilization Review Clinician role (RN, OT, or PT) with a Monday–Friday 1pm–10pm Central schedule. You will review medical records for medical necessity, coordinate care transitions, and ensure high-quality, cost-effective management in post-acute settings.

Candidates should have RN/OT/PT licensure and 4–6 years of clinical experience. Join WellSky to collaborate with physicians and providers, apply clinical decision support tools, and uphold standards while

Qualifications

• Bachelor’s degree or equivalent work experience.
• 4-6 years of clinical nursing or therapy experience.
• Active RN, OT, or PT license.

Responsibilities

• Conduct prior authorization reviews and/or continued stay reviews for post-acute care services using clinical guidelines.
• Approve services in compliance with health plan guidelines and medical necessity criteria.
• Collaborate with case managers, physicians and medical directors for appropriate levels of care.
• Participate in team meetings and interrater reliability activities to ensure review consistency.
• Ensure compliance with federal, state, and accreditation standards; support payer programs.

Skills

MS Office

Clinical judgment

Team collaboration

Communication

Education

Bachelor's degree or equivalent

Tools

MCG Guidelines

InterQual

Clinical decision support tools

Job description

WellSky offers a fully remote Utilization Review Clinician role (RN, OT, or PT) with a Monday–Friday 1pm–10pm Central schedule. You will review medical records for medical necessity, coordinate care transitions, and ensure high-quality, cost-effective management in post-acute settings.

Candidates should have RN/OT/PT licensure and 4–6 years of clinical experience. Join WellSky to collaborate with physicians and providers, apply clinical decision support tools, and uphold standards while