Utilization Review Clinician (RN, PT, OT) - Remote

Overview

This home-based position requires the candidate to live in the state of Oregon and is responsible for reviewing medical records for medical necessity, providing skilled nursing care, and ensuring proper care transitions.

In Short

• Conduct prior authorization and continued stay reviews for post-acute care services.
• Approve services based on health plan guidelines and medical necessity.
• Collaborate with case managers and physicians for seamless care transitions.
• Ensure compliance with federal and state standards.
• Support payer programs related to post-acute care.
• Utilize clinical knowledge for effective care coordination.
• Participate in educational activities for professional growth.
• Willing to travel up to 30% based on business needs.
• Must work in accordance with security policies.
• Must be able to sit and view a computer screen for extended periods.

Requirements

• Bachelor's Degree or equivalent work experience.
• 4-6 years of clinical nursing or therapy experience.
• RN, PT, OT Compact License highly preferred.
• Experience in utilization review and managed care.
• Knowledge of MCG/Interqual criteria.
• Computer skills including MS Office and Clinical Software.
• Ability to pass background checks and drug screening.

Benefits

• Excellent medical, dental, and vision benefits.
• Mental health benefits through TelaDoc.
• Generous paid time off and holidays.
• Paid parental leave.
• 100% vested 401(K) retirement plans.
• Educational assistance up to $2500 per year.