New York Licensed Medical Consultant

Job Summary

A company is looking for a Consultant - Medical (Workers Compensation).

Key Responsibilities

• Conduct independent medical reviews for prior authorization requests related to various benefits
• Provide written clinical rationales and ensure all medical records are organized for review
• Monitor review timeliness and meet production and quality standards consistently

Required Qualifications

• Bachelor's degree with 3-5 years of relevant consulting experience
• Current Registered Nurse (RN) license valid in the state of practice
• Experience in state workers compensation, preferably in New York
• Knowledge of medical terminology, ICD-9/10 Codes, and CPT codes
• Familiarity with utilization review standards and state-specific workers' compensation guidelines