Utilization Reviewer II - RN/Chiropractor, In-Office

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

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.