California Licensed UM Reviewer
Company: VirtualVocations
Location: Vista
Posted on: May 16, 2025
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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, Escondido , California Licensed UM Reviewer, Other , Vista, California
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