Initial Clinical Reviewer - 19121 Wayne, PA 2 DAYS AGO 22720574 Summary Wayne, PA In-Person $28.37 - $35.10 per Hour 1 Years Experience High school graduate or equivalency certificate (GED) No Commission 40.00 hours per week / Day Shift / Full-Time Description

Genex Service LLC Initial Clinical Reviewer US--Remote Job ID:

26-19121

Type:

Regular Full-Time # of

Openings:

1

Category:

Medical Services & Support Mitchell International, Inc. Overview At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth. Be part of a team that makes a real difference. Responsibilities We are seeking a qualified Utilization Reviewer who can work remotely from home. The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in assessing and ensuring the appropriateness of medical treatment plans, contributing to effective claims management and optimal patient outcomes. Uses solid clinical judgment to ensure treatment approved is medically necessary. Forwards treatment requests for physician reviewer that cannot be approved as medically necessary based on application of solid clinical judgment. Collaborates with healthcare providers, claims adjusters, and other stakeholders to gather relevant information for comprehensive assessments. Evaluates medical documentation to ensure compliance with industry standards and regulatory requirements. Communicates findings clearly and concisely through written reports and verbal discussions. Stays up-to-date on industry regulations, medical advancements, and best practices to enhance the quality of reviews. Participates in team meetings and contributes to the continuous improvement of utilization review processes.

Qualifications Required Skills and Experience:

Doctor of Chiropractic (DC) with a valid license in the state of practice Minimum of 2 years of clinical experience; or an advanced degree without experience. Knowledge of medical terminology, treatment modalities, and healthcare View the full job description on the employer's website. Equal employment opportunity, including veterans and individuals with disabilities.

PI285658834 / 13-1141.00

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