California Licensed UM Reviewer

Company: VirtualVocations
Location: Vista
Posted on: May 16, 2025

Job Description:

A company is looking for a UM Reviewer I who applies clinical knowledge to review medical information for treatment necessity.
Key Responsibilities

Render authorization decisions on medical necessity using clinical knowledge
Analyze medical information and facilitate the utilization review process
Communicate with various stakeholders to clarify clinical and claim issues

Required Qualifications

Bachelor of Science in Nursing or related clinical degree preferred; must hold an RN or RPT License
Minimum of three (3) 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

Keywords: VirtualVocations, Bell Gardens , California Licensed UM Reviewer, Other , Vista, California

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