Clinical Utilization Review Specialist
3 days ago
**Company Overview:**
Hines and Associates is a nationwide, independent leader in personalized managed health care. We are committed to conserving health care dollars while ensuring quality care through effective programs and personalized service.
About Our Benefits:
- We offer a competitive salary of $68,000 - $82,000 per year, based on experience.
- A comprehensive benefits package, including medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance.
- A 401(k) plan with a company match, fully vested after 1 year.
Job Description:
This role involves utilizing clinical knowledge and communication skills to obtain patient-specific information regarding patient condition and proposed treatments and procedures. You will determine if illness and/or proposed services meet acceptable criteria sets and acceptable nursing practice guidelines for outpatient treatment or inpatient confinement.
Responsibilities:
- Complete first-level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review.
- Demonstrate ability to assess a patient's current medical status, including complications and untoward events, which may require additional intervention.
- Provide certification of medical, disability, and workers' compensation cases.
Requirements and Qualifications:
- Licensed Practical Nurse with a valid, unrestricted, current nursing license in the state or territory of the United States where employed.
- Successful completion of UR nurse orientation program.
- Minimum of 3 years recent acute clinical practice required; 5 years preferred.
What We Offer:
- No weekends and nights.
- Paid holidays.
- Work-life balance.
- Remote/hybrid setting (once trained).
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