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

EK Health Services•Dallas, TX

2d•Remote

About The Position

EK Health is hiring multiple full-time, remote Utilization Review Health Care Professionals. The role applies clinical and technical knowledge to assess the medical necessity of provider requests for services, using evidence-based guidelines applicable to the claim’s jurisdiction. The work is intended to promote quality, cost-effective outcomes that support individuals’ physical, psychosocial, and vocational health. This is a non-exempt position with Monday–Friday, 8-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. Candidates must provide a safe, HIPAA-compliant home office and a DSL, fiber, or cable internet connection; 100 Mbps or better is preferred.

Requirements

Graduate of an accredited school of nursing, chiropractic, or another related medical program; eligible professional credentials include RN, DC, PT, DPT, LVN, OT, or LAc.
Valid state-specific license in the appropriate scope of practice, in good standing and without restrictions.
Ability to demonstrate the professional and technical skills required for the role.
Excellent written and oral communication skills.
Excellent interpersonal skills.
Strong organizational skills.
High comfort level with computers and programs such as 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 the majority of an 8-hour day, except for lunch and break times.
Ability to keyboard for the majority of an 8-hour day, except for lunch and break times.
Manual dexterity.
Ability to speak on the telephone intermittently throughout the day.
Ability to read and write English fluently.
Ability to provide and confirm a safe home office environment that is HIPAA compliant.
DSL, fiber, or cable internet connection from home.
Applicants residing in California, New York, or Hawaii are not being considered.

Nice To Haves

Utilization Review (UR) experience is highly preferred but not required.
Workers’ Compensation experience is highly preferred but not required.
Internet connection of 100 Mbps or better is preferred.

Responsibilities

Perform a complete evaluation of medical data submitted for a request.
Collect additional relevant data as needed to determine medical necessity.
Analyze collected data to determine medical necessity according to 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 mandated by law.
Coordinate information among involved parties, including the injured worker, physicians, employer, other providers such as therapists, and attorneys, if applicable.
Participate in annual audits of work product to ensure compliance.
Interact professionally, orally and in writing, with EK Health staff, members of the medical community, and EK Health customers.
Participate in teleconferences and staff meetings or trainings as scheduled.
Perform other duties as assigned.