Connected care. Smarter care.
Utilization Review Clinician
Location
United States
Posted
5 days ago
Salary
Not specified
No structured requirement data.
Job Description
Role Description
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
- 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
Job Requirements
- Bachelor's degree or equivalent work experience
- 4-6 years of clinical nursing or therapy experience
- Active RN, OT, or PT license
- 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
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