UR Health Care Professional - Workers Compensation (RN, DC, PT, DPT, LVN, OT, or LAc) - REMOTE!

EK Health Services•Salt Lake City, UT

2d•Remote

About The Position

EK Health Care Services has multiple openings for a Utilization Review Health Care Professional. This role uses technical and clinical knowledge to assess the medical necessity of provider requests for services and applies evidence-based guidelines relevant to the claim’s jurisdiction. The work supports quality, cost-effective outcomes that enhance individuals’ physical, psychosocial, and vocational health. This is a non-exempt, full-time, remote position with Monday–Friday, eight-hour workdays scheduled between 8:30 a.m. and 5:30 p.m. Pacific Standard Time. Applicants residing in California, New York, or Hawaii are not being considered at this time. Pay is $30–$35 per hour, depending on license, experience, and location.

Requirements

Graduate of an accredited school of nursing, chiropractic, or another related medical program (RN, DC, PT, DPT, LVN, OT, or LAc).
Valid state-specific license in the appropriate scope of practice, in good standing and without restrictions.
Possess and demonstrate the professional and technical skills required for the role.
Excellent written and oral communication skills.
Excellent interpersonal skills.
Strong organizational skills.
Comfort using computers and programs including MS Word, MS Excel, and email.
Ability to work independently with minimal supervision.
Ability to meet deadlines in a high-pressure, time-sensitive environment.
Ability to lift up to 20 pounds.
Able to sit for most of an eight-hour day, except during lunch and breaks.
Able to keyboard for most of an eight-hour day, except during lunch and breaks.
Manual dexterity.
Ability to speak on the telephone intermittently throughout the day.
Fluent in reading and writing English.
Able to provide and confirm a safe home-office environment that is HIPAA compliant.
DSL, fiber, or cable internet connection from home; 100 Mbps or better is preferred.

Nice To Haves

Experience in utilization review.
Workers’ compensation experience.

Responsibilities

Evaluate medical data related to service requests.
Collect additional relevant information as needed to determine medical necessity.
Analyze collected data and determine medical necessity using applicable evidence-based guidelines.
Discuss analyzed data and the comprehensive plan of care with the insurance representative before implementation, as needed.
Notify the provider, requester, claimant, carrier, and other parties of decisions as required by law.
Coordinate information among injured workers, physicians, employers, other providers such as therapists, and attorneys when involved.
Participate in annual audits of work product to ensure compliance.
Interact professionally, orally and in writing, with EK Health Services staff, members of the medical community, and customers.
Perform all work within the scope of practice of an RN, DC, PT, DPT, LVN, OT, or LAc.
Participate in teleconferences, staff meetings, and trainings as scheduled.
Perform other duties as assigned.