State Licensed Utilization Reviewer

Job Summary

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

Key responsibilities

• Utilizes clinical judgment to determine the medical necessity of treatment requests
• Collaborates with healthcare providers and stakeholders to gather information for comprehensive assessments
• Communicates findings through written reports and verbal discussions while staying updated on industry regulations and best practices

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, treatment modalities, and healthcare guidelines
• Analytical and critical thinking skills for effective decision-making
• Strong communication and interpersonal skills to liaise with diverse stakeholders