Utilization Reviewer 2

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. 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.

About the role

This is an in-office position located in the Tampa, FL area, Monday - Friday from 9 AM - 5 PM EST. We are seeking a qualified Utilization Reviewer with a PA Registered Nurse or Chiropractor License. The ideal candidate performs utilization review on workers’ compensation related prospective, concurrent, and retrospective treatment referrals, assessing and ensuring the appropriateness of medical treatment plans to contribute to effective claims management and optimal patient outcomes.

Responsibilities

• Use solid clinical judgment to ensure treatment approved is medically necessary.
• Forward treatment requests for physician review that cannot be approved as medically necessary based on clinical judgment.
• Collaborate with healthcare providers, claims adjusters, and other stakeholders to gather relevant information for comprehensive assessments.
• Evaluate medical documentation to ensure compliance with industry standards and regulatory requirements.
• Communicate findings clearly and concisely through written reports and verbal discussions.
• Stay up-to-date on industry regulations, medical advancements, and best practices to enhance the quality of reviews.
• Participate in team meetings and contribute to the continuous improvement of utilization review processes.

Requirements

• Bachelor's degree (minimum education requirement).
• Registered Nurse (RN) or Chiropractor with a valid license in the state of practice (PA license required for this role).
• Minimum of 2 years of clinical experience; or an advanced degree without experience.
• Knowledge of medical terminology, treatment modalities, and healthcare guidelines.
• Analytical and critical thinking skills for effective decision-making.
• Strong communication and interpersonal skills to liaise with diverse stakeholders.
• Ability to work independently and collaboratively within a team environment.
• Detail-oriented with strong organizational skills to manage multiple cases efficiently.
• Familiarity with relevant software and tools used in healthcare.

Desired Skills and Experience

• Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity.
• Prior experience in the workers’ compensation field.

Benefits

We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth, and self. These offerings include:

• Medical, Dental, and Vision insurance.
• Health Savings Accounts / Flexible Spending Accounts.
• Life and AD&D Insurance.
• 401(k) retirement plan.
• Tuition Reimbursement.
• An array of resources that encourage a lifetime of healthier living.

Benefits eligibility may differ depending on full-time or part-time status.

Pay

The expected base pay for this position ranges from $52,750 - $76,000 annually, depending on skills, experience, education, and applicable US geographic market.

Schedule

• Monday - Friday, 9 AM - 5 PM EST.
• In-office position located in the Tampa, FL area.