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

EK Health Services•Reno, NV

2d•Remote

About The Position

EK Health Care is hiring multiple full-time, remote Utilization Review Health Care Professionals to assess medical necessity for provider service requests in workers’ compensation cases. The role applies clinical and technical expertise and jurisdiction-appropriate, evidence-based guidelines to support quality, cost-effective outcomes that promote individuals’ physical, psychosocial, and vocational health. Work must remain within the professional’s scope of practice as an RN, DC, PT, DPT, LVN, OT, or LAc. This is a non-exempt position with an eight-hour workday, Monday through Friday, scheduled between 8:30 a.m. and 5:30 p.m. Pacific time. Applicants residing in California, New York, or Hawaii are not being considered. The role requires a safe, HIPAA-compliant home office and a DSL, fiber, or cable internet connection; 100 Mbps or faster 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.
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 pounds.
Ability to sit and keyboard for most of an eight-hour workday, except for lunch and breaks.
Manual dexterity.
Ability to speak on the telephone intermittently throughout the day.
Fluency in reading and writing English.
Ability to provide and confirm a safe home office environment that is HIPAA compliant.
DSL, fiber, or cable internet connection from home.

Nice To Haves

Utilization Review experience.
Workers’ Compensation experience, highly preferred but not required.
Internet connection of 100 Mbps or faster is preferred.

Responsibilities

Evaluate medical data related to service requests and gather additional relevant information as needed.
Analyze collected data to determine medical necessity using applicable evidence-based guidelines.
As needed, discuss the analyzed data and comprehensive plan of care with the insurance representative before implementation.
Notify the provider, requester, claimant, carrier, and other parties of the determination 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 staff, members of the medical community, and customers.
Participate in teleconferences, staff meetings, and trainings as scheduled.
Perform other duties as assigned.