UR Health Care Professional - Workers Compensation (RN, DC, PT, DPT, LVN, OT, or LAc) - REMOTE!
About The Position
The UR Health Care Professional (HCP) applies technical and clinical knowledge to utilization management, assessing the medical necessity of provider requests for services using evidence-based guidelines applicable to the claim’s jurisdiction. The role supports quality, cost-effective outcomes that promote individuals’ physical, psychosocial, and vocational health. Work must remain within the scope of practice of an RN, DC, PT, DPT, LVN, OT, or LAc. This is a full-time, non-exempt remote position with multiple openings. Work is 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 requires a HIPAA-compliant home office and DSL, fiber, or cable internet; 100 Mbps or faster is preferred.
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.
- High comfort level 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.
- Ability to sit and keyboard for the majority of an eight-hour workday, except during 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 internet connection at home.
Nice To Haves
- Utilization review experience is highly preferred but not required.
- Workers’ compensation experience is highly preferred but not required.
- Home internet speed 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 and 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 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.
- Participate in teleconferences, staff meetings, and trainings as scheduled.
- 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
No Education Listed
