Georgia Licensed Utilization Review Specialist

Job Summary

A company is looking for a Utilization Review Specialist responsible for conducting utilization review services to ensure appropriate and timely care for injured workers.

Key Responsibilities

• Perform precertification reviews and ensure medical requests are related to reported injuries
• Coordinate peer reviews and facilitate telephonic reviews, appeals, and retrospective reviews
• Document all medical and clinical information accurately and maintain compliance with URAC criteria

Required Qualifications

• Registered Nurse (RN) with a minimum of three years of clinical experience
• At least two years of Utilization Review experience in relevant fields (preferred)
• Utilization Review certification such as CPUR or ABQUARP (preferred)
• Current, unrestricted state RN licensure or multi-state compact licensure
• Strong working knowledge of Workers' Compensation laws and managed care arrangements