Utilization Review Health Care Professional - Lvn/Lpn/Physical Therapist

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 – 6:00 pm Pacific Standard time, Work from local office (Rocklin, CA)

Responsibilities may include, but are not limited to:

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

This position pays $30-31/hr based on experience, certifications and location. We offer an excellent benefit package, which includes medical, dental, and vision insurance, 401K, PTO and paid holidays.

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

Physical 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.