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

The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity. This includes conducting patient evaluations, managing admissions and informational visits, and ensuring timely post-discharge follow-ups with completed assessments to help prevent acute care readmissions. In this role, you will also review requests for post-acute services promptly, using established clinical guidelines and coverage criteria to assess appropriateness. You’ll collaborate with physicians, healthcare providers, and both internal and external stakeholders to support improved health outcomes. By applying clinical expertise, you’ll coordinate care with facilities and providers, follow standard operating procedures and organizational policies, and consult with peer reviewers, Medical Directors, or delegated clinical reviewers to ensure care is medically appropriate, high-quality, and cost-effective throughout the medical management process. The ideal candidate will have working knowledge of Microsoft Office applications (e.g., Word, Excel) and be comfortable using clinical decision support tools and operational software. Join us in shaping the future of healthcare - apply today! Key Responsibilities: Conduct prior authorization reviews and/or continued stay reviews for post-acute care services by applying clinical guidelines and escalating cases to medical directors as needed Approve services in compliance with health plan guidelines, contractual agreements, and medical necessity criteria Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care and seamless care transitions Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes Support all payer programs and initiatives related to the