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

EK Health Services Inc.•Salt Lake City, UT

3d•$30 - $35•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 requests for services. UR is a collaborative process intended to promote quality, cost-effective outcomes that support individuals’ physical, psychosocial, and vocational health. The role applies evidence-based guidelines relevant to the claim’s jurisdiction. This is a remote, full-time, non-exempt role. The schedule is Monday through Friday, with 8-hour workdays 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. Compensation is $30–$35 per hour, depending on license, experience, and location. The position requires a 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 applicable 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 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 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 8-hour day, except for lunch and breaks.
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, HIPAA-compliant home office environment.
DSL, fiber, or cable home internet connection; 100 Mbps or faster is preferred.
Must reside outside California, New York, and Hawaii.

Nice To Haves

Utilization Review (UR) experience is preferred but not required.
Workers’ Compensation experience is highly preferred but not required.

Responsibilities

Evaluate all medical data related to a request.
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 the determination, as required by law.
Coordinate information among the injured worker, physicians, employer, 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.
Perform all work within the scope of practice of the applicable license.
Participate in teleconferences, staff meetings, and trainings as scheduled.
Perform other duties as assigned.