UR Health Care Professional
Apply Job Type Full-time 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 Pay & Perks - Pay: $30-35/hr DOE (license, experience, location) - Medical, Dental and Vision insurance - 401K - Paid Time Off - Paid Holidays