Utilization Review Clinician

Job overview

The Utilization Review Clinician role is listed as telecommuter, with schedules generally Monday through Friday or, for a smaller number of positions, Tuesday through Saturday, from 8:00 a.m. to 5:00 p.m. Pacific Time. The national salary range is $80,200–$125,600 per year; a higher national-plus range is also listed for certain markets. The role supports Premera’s health plan utilization management and quality programs. The clinician evaluates provider requests for medical appropriateness and alignment with clinical criteria, policies, benefits, and contracts. The work supports timely, consistent decisions and appropriate, cost-effective care for members across lines of business and geographic regions.

What you'll do

• Conduct medical necessity reviews for inpatient, concurrent, prior authorization, retrospective, out-of-network, and treatment-setting requests
• consult Medical Directors when requests do not meet criteria or policies
• document clinical information accurately and on time
• meet productivity and quality standards
• maintain knowledge of contracts, authorization requirements, guidelines, and policies
• identify members who may benefit from clinical programs
• collaborate with customer service, claims, sales and marketing, and health care services
• support quality improvement initiatives
• maintain regulatory and accreditation compliance.

What we're looking for

Skills & competencies

utilization review clinician

telecommuter

registered nurse

medical necessity review

prior authorization

clinical criteria

inpatient review

outpatient services

pacific time

premera blue cross

$80,200–$125,600 per year

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, vision and dental coverage
• voluntary benefits
• life and disability insurance
• 401(k) match and pension
• wellness resources
• paid time off
• tuition assistance
• employee recognition program.

Why this role

Requires a bachelor’s degree or four years of work experience, current state Registered Nurse licensure, and three years of clinical experience; Washington or Compact RN license and utilization review experience are preferred.

About the employer

Premera Blue Cross is hiring for this role. Industry: Offices of Physical, Occupational and Speech Therapists, and Audiologists. Sector: 62.