Massachusetts Licensed UM Reviewer

Job Summary

A company is looking for a UM Reviewer I.

Key Responsibilities

• Render authorization decisions on the medical necessity of requested treatments using clinical knowledge
• Analyze medical information and facilitate the utilization review process
• Communicate with various stakeholders to clarify clinical and claim issues for case resolution

Required Qualifications

• Bachelor of Science in Nursing or related clinical degree preferred; must hold an RN or RPT License
• Minimum of three 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