Remote Utilization Review Manager Jobs in Morehead, KY

At UK St. Claire, our staff is our greatest asset in the mission to create a healthier and more prosperous population. We strive to foster the talent and potential of our employees and prioritize safe working conditions and equal compensation rates to ensure that continual growth is possible. UKSC is a nurturing workplace for all healthcare professionals. We invite you to explore our current job openings and see if our opportunities could be the right fit for you.
Job Description:
APPI
Job Summary
Responsible for providing direct, high-quality, patient-centered care for patients with routine to moderately complex conditions. This professional utilizes specialized knowledge in their medical or technical field to interpret data and determine appropriate diagnostic and therapeutic procedures. The APP I work under minimal supervision, exercising independent judgment on moderately complex issues while contributing to the advancement of organizational goals.
Essential Functions
• Provide comprehensive clinical care for patients with routine to moderately complex needs, utilizing specialized knowledge to interpret clinical data and determine appropriate interventions.
• Exercise independent judgment regarding patient care processes and moderately complex issues. Modify patient care approaches and processes with management approval as needed.
• Proactively pursue opportunities for educational advancement to meet identified personal and certification needs. Engage in continuous learning to maintain clinical competencies.
• Collaborate with senior professionals to develop clinical methods, techniques, and analytical approaches. Anticipate moderately complex clinical scenarios, developing and discussing potential solutions with management.
• Identify opportunities for management regarding process and quality improvement, including the development of new clinical services for the specific discipline.
• Adherence to department-specific clinical guidelines, schedules, volume expectations, and equipment utilization as directed by clinical leadership and departmental policy.
• Actively participate in the maintenance of quality improvement initiatives, peer review processes, and patient safety protocols. Ensure full compliance with regulatory standards (e.g., Joint Commission, CMS) and organizational policies.
• Maintain accurate, timely, and thorough electronic medical records within the organization's platform. Ensure all documentation meets billing, coding, and legal requirements.
• Work effectively within a multi-disciplinary care team, including nursing, allied health, and clinical leadership. Provide clear, empathetic communication to patients and their families regarding diagnoses and treatment plans.
• Engage in ongoing learning to maintain board certification, licensure, and clinical competencies. Participate in departmental meetings and contribute to clinical practice improvements.
• Uphold the values of the organization, fostering an environment of inclusivity, safety, and operational efficiency. Participate in system-wide initiatives and support the successful integration of new clinical workflows.
• Adherence to department-specific clinical guidelines, call schedules, volume expectations, and equipment utilization as directed by clinical leadership and departmental policy.
Education Requirement
Master's Degree in a Nurse Practitioner Program, Physician Assistant Program, or other specialized clinical advanced education (e.g., Midwifery, Anesthesia)
Experience Requirement
Demonstrated ability to work under minimal supervision and utilize independent judgment in daily practice
An equivalent combination of education and experience may be considered.
All experience must be paid and in the same related field.
Part-time and PRN experience will be prorated based on hours worked per week.
Volunteer work and internships for academic credit are not counted.
Certifications & Licensures
Current, unrestricted specialty license/certifications as applicable to the job.
Active and unrestricted as a Registered Nurse and Nurse Practitioner or Physician Assistant in the State of Kentucky (Ohio, if applicable)
National Board Certification in the relevant specialty, if applicable
Certifications in BLS, PALS, and ACLS, if applicable.
Working Conditions
A. Lifting, pushing, and/or pulling objects up to 50lbs:2. Occasional (< 10% of the time)
B. Lifting, pushing, and/or pulling objects over 50lbs:1. Never
C. Standing or walking with objects up to 10lbs:3. Intermittent (10% - 50% of the time)
D. Standing or walking with objects up to 25lbs:2. Occasional (< 10% of the time)
E. Sitting at computer workstation for extended periods:3. Intermittent (10% - 50% of the time)
F. Risk of back injury from moving, lifting, or positioning patients, equipment, or materials:2. Occasional (< 10% of the time)
G. Repetitive motion:3. Intermittent (10% - 50% of the time)
H. Working at heights above 4 feet:1. Never
I. Working in confined spaces:1. Never
J. Risk of injuries from use of equipment on the job:2. Occasional (< 10% of the time)
K. Job-related travel:1. Never
L. Loud noises:2. Occasional (< 10% of the time)
M. Temperature extremes:2. Occasional (< 10% of the time)
N. Hazardous chemicals and fumes including waste:2. Occasional (< 10% of the time)
O. Radiation:1. Never
P. Burns:1. Never
Q. Cuts/Punctures:2. Occasional (< 10% of the time)
R. Bloodborne/airborne pathogens: 3. Intermittent (10% - 50% of the time)
S. Recombinant DNA or viral vectors:1. Never
T. Combative/violent people:2. Occasional (< 10% of the time)
U. Animal handling (including carcasses):1. Never
V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular):N/A
Physical Demands
This position requires intermittent sitting at a computer workstation for extended periods of time; performing tasks with repetitive motions (such as typing or patient care); intermittent standing or walking with objects weighing up to 10 pounds; and occasionally standing or walking with objects up to 25 pounds; and lifting, pushing, and/or pulling objects weighing up to 50 pounds. Also involves some exposure to risk of injury from moving, lifting, or positioning patients or equipment; and occasional exposure to hazardous chemicals and fumes including waste, cuts/punctures, and intermittent exposure to bloodborne or airborne pathogens.
Additional Job Descriptions
N/A
Department:
UTC 60
Shift:
Days (United States of America)
Time Type:
Full time
Address:
1028 E. Main St.
City, State:
Morehead, Kentucky