[Hiring] Utilization Review Health Care Professional @EK Health Services Inc.

Role Description

Please note: At this time, we are not accepting or considering applicants residing in California (CA), New York (NY), or Hawaii (HI).

EK Health has multiple openings for this role!

UR is a collaborative process to promote quality cost-effective outcomes, which enhance the physical, psychosocial, and vocational health of individuals. The HCP applies and provides technical and clinical knowledge and experience to the field of utilization management to assess the medical necessity of provider requests for services. The UR HCP will be able to apply evidence-based guidelines applicable to the jurisdiction for the claim.

Position Logistics:

• Non-Exempt, Full-time
• Monday – Friday, 8-hour workdays, between 8:30am – 5:30 pm Pacific Standard Time
• Remote

Responsibilities may include, but are not limited to:

• Assessment:
  • Perform a complete evaluation of the medical data for the request
  • Collect additional relevant data as needed to decide on medical necessity
  • Analyze the collected data to determine medical necessity as per evidence-based guidelines
• Planning:
  • Discuss the analyzed data and the comprehensive plan of care with the insurance representative prior to implementation as needed
  • Upon determination, provide notification of decision to provider, requester, claimant, carrier, and all other parties as mandated by law
• Implementation:
  • Coordinates information between all parties (injured worker, physicians, employer, other providers, such as therapists, and attorney, if any are involved)
• Evaluation:
  • Participate in annual audits of work product to ensure compliance
  • Professional interaction with EKHS staff, members of the medical community, and all customers of EKHS; both in oral and written forms
  • All work is done within the scope of practice of an RN, DC, PT, DPT, LVN, OT, or LAc
  • Participate in teleconferences and staff meetings/trainings as scheduled
  • Other duties as assigned

Qualifications

• Graduate of an accredited school of nursing, chiropractic, or another related medical program (RN, DC, PT, DPT, LVN, OT, LAc)
• Valid state-specific license in the appropriate scope of practice in good standing with no restrictions
• Possesses and can demonstrate the professional and technical skills required
• Experience in UR, Workers' Compensation experience highly preferred, but not required
• Excellent Written and Oral Communication Skills
• Excellent Interpersonal Skills
• Strong Organization Skills
• High comfort level with computers and computer programs (MS Word, MS Excel, Email)
• Ability to work independently with minimal supervision
• Ability to meet deadlines in a high pressure, time sensitive environment
• Ability to lift to 20 lbs.

Requirements

• Candidate must be able to sit the majority of an 8-hour day except for lunch and break times.
• Candidate must be able to keyboard the majority of an 8-hour day except for lunch and break times.
• Candidate must have manual dexterity.
• Candidate must be able to speak on the telephone intermittently throughout the day.
• Candidate must be able to read and write English fluently.
• Candidate must be able to provide and confirm safe home office environment.
• Home office must be HIPAA compliant.
• Requires DSL, fiber, or cable internet connection from home 100 Mbps preferred or better.

Benefits

• Pay: $30-35/hr DOE (license, experience, location)
• Medical, Dental and Vision insurance
• 401K
• Paid Time Off
• Paid Holidays
• Monthly Internet Stipend