[Remote] Utilization Review Clinician at WellSky

The Utilization Review Clinician will conduct timely reviews of post-acute service requests using clinical guidelines and coverage limitations to determine service appropriateness. They will build relationships with healthcare providers and clients to enhance enrollee health outcomes, apply clinical knowledge for care coordination with facilities and providers, and consult with peer reviewers and Medical Directors to ensure medically appropriate, quality, and cost-effective care. Key duties include performing prior authorization and continued stay reviews, approving services in compliance with guidelines, collaborating with case managers and physicians for appropriate care levels and transitions, participating in team meetings and educational activities, ensuring compliance with federal, state, and accreditation standards, supporting payer programs, making benefit determinations, coordinating benefits and transitions, and utilizing knowledge of healthcare system resources.