Utilization Reviewer 2

Enlyte; Northern (KY); Hybrid; USD 53,000 - 76,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401(k)

Tuition Reimbursement

Job summary

Enlyte is seeking a qualified Utilization Reviewer for an in-office role in the Wayne, PA area. The position requires PA RN or Chiropractor license and involves reviewing workers’ compensation treatment referrals to ensure medical necessity.

Responsibilities include collaborating with providers and claims adjusters, evaluating documentation for compliance, and communicating findings clearly. The role emphasizes ongoing professional development and adherence to regulatory standards.

Qualifications

• Bachelor's degree required.
• RN or LVN with a valid license in the state of practice.
• Minimum 2 years of clinical experience; or an advanced degree without experience.

Responsibilities

• Perform utilization review on workers’ compensation related prospective, concurrent, and retrospective treatment referrals.
• Assess and ensure medical treatment plans are appropriate and medically necessary.
• Collaborate with healthcare providers, claims adjusters, and other stakeholders to gather information.
• Evaluate medical documentation for compliance with industry standards and regulations.
• Communicate findings through reports and discussions; stay updated on regulations and best practices.
• Participate in team meetings to improve utilization review processes.

Skills

Analytical thinking

Communication skills

Detail-oriented

Team collaboration

Healthcare software

Education

Bachelor's degree

Tools

Healthcare software

Job description

Company Overview

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.

Job Description

This is an In Office Position from Monday - Friday from 9 AM - 5 PM EST

PA Registered Nurse or Chiropractor License Required

We are seeking a qualified Utilization Reviewer located in the Wayne, PA area. The ideal candidate performs utilization review on workers’ compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in assessing and ensuring the appropriateness of medical treatment plans, contributing to effective claims management and optimal patient outcomes.

• Uses solid clinical judgment to ensure treatment approved is medically necessary.
• Forwards treatment requests for physician reviewer that cannot be approved as medically necessary based on application of solid clinical judgment.
• Collaborates with healthcare providers, claims adjusters, and other stakeholders to gather relevant information for comprehensive assessments.
• Evaluates medical documentation to ensure compliance with industry standards and regulatory requirements.
• Communicates findings clearly and concisely through written reports and verbal discussions.
• Stays up-to-date on industry regulations, medical advancements, and best practices to enhance the quality of reviews.
• Participates in team meetings and contributes to the continuous improvement of utilization review processes.

Qualifications

Minimum Education: Bachelor's degree.

Required Skills and Experience:

• Registered Nurse (RN) or LVN with a valid license in the state of practice.
• Minimum of 2 years of clinical experience; or an advanced degree without experience.
• Knowledge of medical terminology, treatment modalities, and healthcare guidelines.
• Analytical and critical thinking skills for effective decision-making.
• Strong communication and interpersonal skills to liaise with diverse stakeholders.
• Ability to work independently and collaboratively within a team environment.
• Detail-oriented with strong organizational skills to manage multiple cases efficiently.
• Familiarity with relevant software and tools used in healthcare.

Desired Skills and Experience:

• Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity.
• Prior experience in the workers' compensations field.

Benefits

We’re committed to supporting your ultimate well‑being through our total compensation package offerings that support your health, wealth and self.

These offerings include:

• Medical
• Dental
• Vision
• Health Savings Accounts / Flexible Spending Accounts
• Life and AD&D Insurance
• 401(k)
• Tuition Reimbursement
• an array of resources that encourage a lifetime of healthier living

Benefits eligibility may differ depending on full-time or part‑time status.

Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $52,750 - $76,000 annually, and will be based on a number of additional factors including skills, experience, and education.

The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

Don’t meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.

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