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Utilization Review Physician Assistant Jobs in Puerto Rico

San Juan Capestrano

Utilization Coordinator

San Juan, PR · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

Encompass Health

Case Manager

Manati, PR · On-site

$17 - $21.75/hr

Schedule and facilitate family conferences as needed. * Assist patient with timely procuring ... Participate in utilization review process: data collection, trend review, and resolution actions.

Veterans Health Administration

$145K - $335K/yr

... after review of the EDRP application. Former EDRP participants ineligible to apply. Learn more ... utilization of health care resources. The Physiatrists Section Chief assists the ACOS for Rehab in ...

DaVita

Inventory Clerk

Carolina, PR · On-site

$11.25 - $13.50/hr

... utilization of the dialysis facility inventory and inventory system in accordance with DaVita ... These must be reviewed with management. However, in general, the position requires the following ...

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Utilization Review Physician Assistant information

What is a utilization review physician assistant?

A Utilization Review Physician Assistant (PA) is a healthcare professional who evaluates medical records and treatment plans to ensure that patient care is medically necessary, appropriate, and cost-effective. They review cases to determine if the care provided meets established guidelines and insurance requirements. Utilization Review PAs collaborate with physicians, nurses, insurance companies, and other healthcare providers to promote quality care while managing healthcare resources efficiently. Their work typically involves less direct patient care and more administrative responsibilities compared to traditional clinical PA roles.

What are the key skills and qualifications needed to thrive as a utilization review physician assistant?

To thrive as a Utilization Review Physician Assistant, you need a strong clinical background, current PA licensure, and in-depth knowledge of medical guidelines and insurance protocols. Familiarity with electronic medical records (EMRs), utilization management software, and relevant certification such as the Certified Professional in Utilization Review (CPUR) is often beneficial. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for evaluating cases and interacting with healthcare providers and payers. These competencies are essential to ensure appropriate care delivery, compliance with regulations, and cost-effective use of medical resources.

What are some of the main challenges utilization review physician assistants face when transitioning from direct patient care to a review-focused role?

One of the main challenges Utilization Review Physician Assistants encounter is adapting to a predominantly administrative and analytical environment, as opposed to the hands-on patient care they may be accustomed to. The role requires interpreting clinical documentation, applying payer criteria, and making objective determinations about medical necessity, often with limited patient interaction. Additionally, there can be pressure to meet productivity targets and deadlines while maintaining accuracy and fairness in reviews. Collaboration with physicians, case managers, and insurance representatives is frequent, requiring strong communication and negotiation skills.

What is the difference between Utilization Review Physician Assistant vs Utilization Review Nurse Practitioner?

AspectUtilization Review Physician AssistantUtilization Review Nurse Practitioner
CredentialsMaster's degree, Physician Assistant (PA) license, certification (e.g., NCCPA)Master's or higher degree, Nurse Practitioner (NP) license, certification (e.g., ANCC, AANP)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, clinics, insurance companies
Employer & Industry UsageCommonly employed in healthcare and insurance sectors for review rolesSimilar usage, often in outpatient and insurance settings

Both roles involve reviewing medical necessity and appropriateness of care, but the Physician Assistant typically has a medical model training background, while the Nurse Practitioner has a nursing model. Both are vital in utilization review, with overlapping responsibilities and work environments.

Can physician assistants do utilization review?

Yes, physician assistants can perform utilization review tasks, which involve evaluating the necessity, appropriateness, and efficiency of healthcare services. They often work in collaboration with physicians and may require certification or training in utilization review processes, depending on the healthcare setting and state regulations.

What are popular job titles related to Utilization Review Physician Assistant jobs in Puerto Rico?

For Utilization Review Physician Assistant jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Utilization Review Physician Assistant jobs in Puerto Rico look for?

The top searched job categories for Utilization Review Physician Assistant jobs in Puerto Rico are:

What cities in Puerto Rico are hiring for Utilization Review Physician Assistant jobs?

Cities in Puerto Rico with the most Utilization Review Physician Assistant job openings:

Utilization Review Physician Assistant jobs near you

Physician Assistant (Mid-Level Practitioner) - Recruitment Incentive

Department of Justice

Guaynabo, PR • On-site

$57K/yr

Full-time

Posted 29 days ago

Job description

Corrections professionals who foster a humane and secure environment and ensure public safety by preparing individuals for successful reentry into our communities.
Qualifications:

Basic Requirements:
All applicants must meet the following basic requirements for all grade levels:

  • Graduation from a physician assistant educational program, accredited by the Accreditation Review Committee on Education for the Physician Assistant (ARC-PA) or its predecessors, at a college, university, or educational institution that is accredited by an accrediting body or organization recognized by the U.S. Department of Education at the time the degree was obtained.
  • Successful completion of the National Commission on Certification of Physician Assistants (NCCPA) examination; must maintain status as a certified physician assistant, including completion of all requirements for Continuing Medical Education (CME) and re-certification.

NOTE: ALL applicants MUST electronically upload proof of completion of the National Commission on Certification of Physician Assistants (NCCPA) examination, including completion of all requirements for continuing medical education (CME) and recertification.
AND
Licensure: For ALL grade levels and positions, applicants must possess and electronically upload proof of a current, active, full, and unrestricted license or registration as a Physician Assistant from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.
All qualified referred candidates will undergo a credentialing process prior to employment with the Bureau of Prisons. This process includes validation of medical examinations, education, internship and residency. Please electronically upload these documents along with your required supporting documentation at the time you apply.
AND
Additional Requirements:
GS-07: Applicants must meet at least one of the following requirements:

  • Completion of an accredited physician assistant educational program (certificate of completion, associate degree, bachelor's degree); OR
  • Completion of a bachelor's degree in a related health care or health related science and graduation from an accredited physician assistant educational program.

GS-09: In addition to the requirements for the GS-07 (or equivalent) level, applicants must meet one of the following requirements:

  • Completion of Master of Physician Assistant Studies; OR
  • Completion of a master's degree in a related health care or health related science and completion of an accredited physician assistant educational program. Examples of related master's degree programs include, but are not limited to, Master of Medical Sciences, Master of Public Health, Master of Biomedical Sciences, or other related major fields of study; OR
  • A minimum of one full year of work experience as a certified physician assistant equivalent to the GS-07 grade level and graduation from an accredited physician assistant educational program as described above.

GS-11: In addition to the requirements for the GS-09 (or equivalent) level, applicants must meet one of the following requirements:

  • Completion of Doctorate of Physician Assistant Studies, Doctorate of Science Physician Assistant (DScPA) or equivalent; OR
  • Completion of a PhD or equivalent doctoral degree in a related health field and completion of an accredited physician assistant educational program. Examples of related doctoral degree programs include, but are not limited to, public health; allied health field; public health education; or other related health science programs; OR
  • A minimum of one full year of work experience as a certified physician assistant equivalent to the GS-09 grade level and completion of an accredited physician assistant educational program as described above.

Some examples of this qualifying experience are:
GS-09:

  • Experience performing minor surgical procedures, such as, incision and drainage, suturing of laceration, and removal of cysts after consultation with the physician.
  • Experience treating chronic health problems, such as hypertension and diabetes.
  • Experience providing preventive care and guidance in treating a variety of common illnesses, as well as guidance on nutrition.

GS-11:

  • Experience identifying medical problems and determining appropriate action to treat the problem, including referral to a physician.
  • Experience performing specified diagnostic and therapeutic practices and procedures.
  • Experience providing a wide range of emergency services in the absence of the physicians, including primary care for trauma and life-saving procedures.

If applicable, credit will be given for paid and unpaid experience. To receive proper credit, you must show the actual time (such as the number of hours worked per week) spent in activities.
**Your eligibility for consideration will be based on your responses to the questions in the application.**

Education:ONLY if education is a requirement/substitution for specialized experience, applicant MUST upload legible transcripts as verification of educational requirement. Transcripts MUST be uploaded and electronically linked from USAJOBS at the time you apply and MUST include identifying information to include School Name, Student Name, Degree and Date Awarded (if applicable). All academic degrees and coursework must be completed at a college or university that has obtained accreditation or pre-accreditation status from an accrediting body recognized by the U.S. Department of Education. For a list of schools that meet this criteria, Click Here.
Foreign Education: For information regarding foreign education requirements, please see Foreign Diploma and Credit Recognition at the U.S. Department of Education website: Recognition of Foreign Qualifications.
If you are selected for this position and qualified based on education (i.e. basic education requirement and/or substitution of education), you will be required to provide an OFFICIAL transcript prior to your first day on duty.Employment Type: OTHER

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