Clearcareonline
Utilization Review Clinician (RN, PT, OT) - Remote
Remote - US · Full-time
No sponsorshipDetected 1 day ago
ExcelCommunicationCollaborationMicrosoft Office
About the role
- This role will require the successful candidate to work one of two available shifts: Monday to Friday, 1pm to 10pm Central (2pm to 11pm Eastern), OR Saturday through Tuesday, 7am to 6pm Central.
- The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity.
- This includes conducting patient evaluations, managing admissions and informational visits, and ensuring timely post-discharge follow-ups with completed assessments to help prevent acute care readmissions.
Responsibilities
- Support all payer programs and initiatives related to the post-acute space
- Perform other job duties as assigned
Requirements
- Bachelor's degree or equivalent work experience
- 4-6 years of clinical nursing or therapy experience
Nice to have
- 1-2 years' experience in utilization review, case management and/or managed care regulations
- Experience with MCG Guidelines, InterQual or other clinical decision support tools, especially in utilization management and prior authorization processes
- Job Expectations:
- Willing to travel up to 20% 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
- We thrive on innovation, inclusiveness, and cohesive perspectives.
Compensation
- Educational assistance up to $2500 per year
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
- Conduct prior authorization reviews and/or continued stay reviews for post-acute care services by applying clinical guidelines and escalating cases to medical directors as needed
- Approve services in compliance with health plan guidelines, contractual agreements, and medical necessity criteria
- Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care and seamless care transitions
- Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth
- Make benefit determinations about appropriate levels of care using clinical guidelines
- Coordinate benefits and transitions between various areas of care
- Utilize knowledge of resources available in the healthcare system to assist physicians and patients effectively
Visa & Work Authorization
- Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States.
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This listing is sourced directly from Clearcareonline's careers page and normalized into a canonical job model.