UR Health Care Professional - Workers Compensation (RN, DC, PT, DPT, LVN, OT, or LAc) - REMOTE!
About The Position
EK Health is hiring multiple Utilization Review (UR) Health Care Professionals to apply technical and clinical knowledge to assess the medical necessity of provider service requests. The role applies evidence-based guidelines relevant to the claim’s jurisdiction and supports quality, cost-effective outcomes that promote individuals’ physical, psychosocial, and vocational health. This is a full-time, non-exempt remote position, Monday through Friday, with 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. The role is performed within the scope of practice of an RN, DC, PT, DPT, LVN, OT, or LAc. A HIPAA-compliant home office and a DSL, fiber, or cable internet connection are required; 100 Mbps or better is preferred.
Requirements
- Graduate of an accredited school of nursing, chiropractic, or another related medical program, with an RN, DC, PT, DPT, LVN, OT, or LAc qualification.
- Valid state-specific license in the appropriate scope of practice, in good standing and without restrictions.
- Possess and demonstrate the required professional and technical skills.
- 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 lbs.
- Ability to sit for most of an eight-hour workday, apart from lunch and breaks.
- Ability to keyboard for most of an eight-hour workday, apart from lunch and breaks.
- Manual dexterity.
- Ability to speak on the telephone intermittently throughout the day.
- Fluent English reading and writing ability.
- Ability to provide and confirm a safe home office environment.
- Home office must be HIPAA compliant.
- DSL, fiber, or cable internet connection from home; 100 Mbps or better is preferred.
Nice To Haves
- Experience in utilization review (UR) is highly preferred but not required.
- Workers’ Compensation experience is highly preferred but not required.
Responsibilities
- Perform a complete evaluation of medical data for each request.
- Collect additional relevant data 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 EKHS staff, members of the medical community, and EKHS customers.
- Participate in scheduled teleconferences, staff meetings, and trainings.
- Perform other duties as assigned.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- 401(k)
- Paid time off
- Paid holidays
- Monthly internet stipend
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
