Remote Utilization Review Specialist (Healthcare Pro)

EK Health Services Inc.; Dallas (TX); Remote; USD 41,000 - 48,000; Full time

Benefits offered by this job

Medical, Dental and Vision insurance

401K

Paid Time Off

Paid Holidays

Monthly Internet Stipend

Job summary

EK Health Services Inc. is hiring for a Utilization Review healthcare professional in a remote, full-time capacity.

The UR HCP applies clinical knowledge to assess the medical necessity of provider requests and uses evidence-based guidelines appropriate to the jurisdiction for claims. This role emphasizes collaboration with insurers, providers, and patients, requires nursing or related license, and offers benefits including medical, dental, and vision, a 401K, PTO, holidays, and a monthly

Qualifications

• Graduate of an accredited school of nursing, chiropractic, or another related medical program (RN, DC, PT, DPT, LVN, OT, LAc).
• Valid state-specific license in the appropriate scope of practice in good standing with no restrictions.
• Experience in UR; Workers' Compensation experience preferred but not required.

Responsibilities

• 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 per guidelines.
• Discuss the analyzed data and plan of care with the insurance representative as needed.
• Provide notification of decision to provider, requester, claimant, carrier, and others as mandated.
• Coordinate information between all parties and participate in teleconferences and trainings.

Skills

UR experience

Clinical nursing license

Strong communication

Education

Nursing or related medical program degree

Tools

MS Word

MS Excel

Email

Job description

EK Health Services Inc. is hiring for a Utilization Review healthcare professional in a remote, full-time capacity.

The UR HCP applies clinical knowledge to assess the medical necessity of provider requests and uses evidence-based guidelines appropriate to the jurisdiction for claims. This role emphasizes collaboration with insurers, providers, and patients, requires nursing or related license, and offers benefits including medical, dental, and vision, a 401K, PTO, holidays, and a monthly