California Licensed UM Reviewer

A company is looking for a UM Reviewer I who applies clinical knowledge to review medical information for treatment necessity. Key Responsibilities Render authorization decisions on medical necessity using clinical knowledge Analyze medical information and facilitate the utilization review process Communicate with various stakeholders to clarify clinical and claim issues Required Qualifications Bachelor of Science in Nursing or related clinical degree preferred; must hold an RN or RPT License Minimum of three (3) years of diverse clinical experience or prior experience in managed care/workers compensation Possess clinical training and knowledge consistent with RN or RPT licensure Ability to make independent clinical decisions within the scope of RN/RPT licensure Current RN home state licensure in good standing without restrictions

Apr 24, 2025 - 22:14

A company is looking for a UM Reviewer I who applies clinical knowledge to review medical information for treatment necessity. Key Responsibilities Render authorization decisions on medical necessity using clinical knowledge Analyze medical information and facilitate the utilization review process Communicate with various stakeholders to clarify clinical and claim issues Required Qualifications Bachelor of Science in Nursing or related clinical degree preferred; must hold an RN or RPT License Minimum of three (3) years of diverse clinical experience or prior experience in managed care/workers compensation Possess clinical training and knowledge consistent with RN or RPT licensure Ability to make independent clinical decisions within the scope of RN/RPT licensure Current RN home state licensure in good standing without restrictions