State Licensed Utilization Reviewer

Job Summary

Working remotely on a full-time basis, the State Licensed Utilization Reviewer will perform utilization reviews on workers' compensation treatment referrals, ensuring medical necessity and contributing to effective claims management.

Key responsibilities:

• Utilize clinical judgment to assess and approve treatment plans based on medical necessity
• Collaborate with healthcare providers and stakeholders to gather information for comprehensive assessments
• Evaluate medical documentation for compliance with industry standards and communicate findings effectively

Required qualifications:

• Doctor of Chiropractic (DC) with a valid license in the state of practice
• Minimum of 2 years of clinical experience or an advanced degree without experience
• Knowledge of medical terminology and healthcare guidelines
• Strong analytical and critical thinking skills
• Detail-oriented with strong organizational skills to manage multiple cases efficiently