[Hiring] Utilization Review Clinician @WellSky

Role Description

This role will require the successful candidate to work the shift of Monday to Friday, 1pm to 10pm Central (2pm to 11pm Eastern).

The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity. This includes:

• Conducting patient evaluations
• Managing admissions and informational visits
• Ensuring timely post-discharge follow-ups with completed assessments to help prevent acute care readmissions

In this role, you will also:

• Review requests for post-acute services promptly, using established clinical guidelines and coverage criteria to assess appropriateness
• Collaborate with physicians, healthcare providers, and both internal and external stakeholders to support improved health outcomes
• Apply clinical expertise to coordinate care with facilities and providers
• Follow standard operating procedures and organizational policies
• Consult with peer reviewers, Medical Directors, or delegated clinical reviewers to ensure care is medically appropriate, high-quality, and cost-effective throughout the medical management process

The ideal candidate will have working knowledge of Microsoft Office applications (e.g., Word, Excel) and be comfortable using clinical decision support tools and operational software.

Join us in shaping the future of healthcare - apply today!

Qualifications

• Bachelor's degree or equivalent work experience
• 4-6 years of clinical nursing or therapy experience
• Active RN, OT, or PT license

Requirements

• 1-2 years' experience in utilization review, case management and/or managed care regulations (preferred)
• Experience with MCG Guidelines, InterQual or other clinical decision support tools, especially in utilization management and prior authorization processes (preferred)
• Willing to travel up to 30% based on business needs
• Willing to work additional or irregular hours as needed
• Must work in accordance with applicable security policies and procedures to safeguard company and client information
• Must be able to sit and view a computer screen for extended periods of time

Benefits

• Excellent medical with Rx, dental, and vision benefits
• Mental Health support through EAP
• Generous paid time off, plus 13 paid holidays
• 100% vested 401(K) retirement plans
• Educational assistance up to $2500 per year