Pennsylvania Licensed Utilization Reviewer

Job Summary

A company is looking for a Utilization Reviewer who can work remotely from home.

Key Responsibilities

• Perform utilization review on workers' compensation treatment referrals to assess 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

• Active Registered Nurse (RN) license in the state of PA
• Minimum of 2 years of clinical experience or an advanced degree without experience
• Knowledge of medical terminology and healthcare guidelines
• Analytical and critical thinking skills for decision-making
• Familiarity with relevant software and tools used in healthcare