We encourage you to reach out and understand the opportunities that await with stable staffing, a great reputation and wonderful career experience. We believe in creating a warm, welcoming environment for our residents that helps them feel safe and cared for. Our staff are there to support them as much as possible in their daily lives.
SALMON Health and Retirement offers a generous tuition reimbursement program for nursing-related programs and other degree programs relevant to your role. Your career goals are our goals, too. The right benefits can make your life better. We want you to feel seen, heard, valued and cared for, which is why we offer competitive wages, tuition reimbursement and student loan repayment, wellness perks, generous paid holidays and paid time off, free tickets to sporting events, life insurance, health insurance, dental insurance, a 401(k) plan and more.
About the Role:
The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of patient care plans, medical records, and treatment protocols to determine appropriate levels of care and resource utilization. The specialist collaborates closely with healthcare providers, insurance companies, and case managers to facilitate timely approvals and optimize patient outcomes. By analyzing clinical data and applying evidence-based guidelines, the role helps to control costs while maintaining high-quality care standards. Ultimately, the Utilization Review Specialist supports the organization’s mission to deliver effective and responsible healthcare services within the Information and Media Services industry at SALMON Home Care.
QUALIFICATIONS:
Education:
- Associate or bachelor’s degree in nursing (ADN or BSN) required.
- BSN preferred.
Licensure/Certification:
- Current and active Registered Nurse (RN) license in the practicing state.
- Certification in Utilization Review, Case Management, or Quality (e.g., CCM, URAC, CPUR) preferred but not always required.
- Certification in OASIS and ICD-10 coding guidelines required.
- BLS (Basic Life Support) certification may be required.
Experience:
- Minimum of 2–3 years of clinical nursing experience, preferably in home health or community-based care.
- At least 1–2 years of experience in utilization review, case management, or quality assurance strongly preferred.
Familiarity with Medicare/Medicaid and private insurance requirements for home health services.
Shift and schedule - full time, Monday - Friday 40 hours. One day each week in office is required, the remainder can be remote.
Benefits
- Dental insurance
- Health insurance
- Life insurance
- Loan repayment program
- Paid time off
- Tuition reimbursement