Job Overview
Location
2 Locations
Job Type
Full-time
Category
HR & Recruiting
Date Posted
June 20, 2026
Full Job Description
đź“‹ Description
- • The Utilization Review Clinician (RN, OT, or PT) is responsible for reviewing medical records to determine medical necessity, conducting patient evaluations, managing admissions and informational visits, and ensuring timely post-discharge follow-ups to help prevent acute care readmissions.
- • Day-to-day responsibilities include conducting prior authorization and continued stay reviews for post-acute care services using clinical guidelines, approving services in compliance with health plan guidelines and medical necessity criteria, collaborating with physicians and case managers to ensure appropriate care levels and seamless transitions, participating in team meetings and interrater reliability testing, and coordinating benefits and transitions between various areas of care.
- • WellSky Corporation is a healthcare technology company focused on improving health outcomes through innovation, inclusiveness, and collaboration, providing solutions that support post-acute care and medical management processes.
- • In this role, you will develop expertise in utilization review, clinical decision support tools, and healthcare compliance while contributing to cost-effective, high-quality patient care and gaining experience in prior authorization, case management, and managed care regulations.
🎯 Requirements
- • Bachelor's degree or equivalent work experience
- • 4-6 years of clinical nursing or therapy experience
- • Active RN, OT, or PT license
Skills & Technologies
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About WellSky Corporation
WellSky Corporation provides healthcare software and analytics solutions for post-acute care, blood management, human services, and specialty pharmacy. Its cloud-based platforms support home health, hospice, palliative care, blood centers, pharmacies, and state and community agencies, integrating clinical workflows, billing, compliance reporting, and data analytics. The company helps providers improve patient outcomes, operational efficiency, and regulatory compliance across the continuum of care.
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