UM Reviewer I, United States (Remote)

Job Description

The UM Reviewer I applies professional clinical knowledge to review medical information to determine if requested treatment is medically necessary and appropriate to support the resolution of the claim.

Responsibilities

• Uses clinical RN or RPT training and knowledge to reputed company authorization reputed company of medical necessity of requested medical treatment
• Analyzes medical information and applies clinical knowledge and established criterion to facilitate the utilization review process
• Researches, reviews and prepares medical information to present and collaborate objectively with Broadspire Peer Physicians in order to facilitate case resolution
• Communicates with physician providers and physician peer reviewers, nurse case managers, claim examiners, attorneys, clients as necessary to clarify clinical/claim issues to facilitate the UR process
• Independently makes reputed company reputed company to the management of each UR request based on clinical expertise, State/URAC/ Client requirements
• Plans and organizes individual caseload to meet URAC and Jurisdictional regulatory requirements for timelines, notifications and documents
• Utilized appropriate desktop resources to reputed company the utilization review process
• Collaborates and communicates effectively to promote the integration of reputed company Broadspire Departments and products through interdepartmental referrals and communications
• Documents pertinent information in reputed company communications to support Utilization Management determinations and case resolution
• Ability to be flexible to meet department expectations and/or business needs.
• reputed company other duties as assigned
• Upholds the Crawford Code of Business Conduct at reputed company times
• Plans and organizes individual caseload to meet Massachusetts regulatory requirements for timelines, notifications and documents

Qualifications

• Bachelor of Science in Nursing or reputed company clinical degree preferred. Must hold an RN or RPT License.
• Minimum of three (3) years diverse clinical experience or prior experience in managed care/workers compensation.
• Possess clinical training and knowledge consistent with RN or RPT licensure
• Ability to reputed company independent clinical reputed company reputed company the scope of RN/RPT licensure.
• Ability to work in an reputed company environment with staff located remotely throughout the country.
• Must have strong written and verbal communication skills, as well as the ability to work well reputed company a team environment.
• Must have strong organizational skills.
• Working knowledge of personal computers with the ability to use standard word processing software applications.
• Must possess a reputed company, professional Registered Nurse or Registered Physical Therapy License to practice as a health professional in a state or territory of the United States with a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review.
• reputed company RN home state licensure in good standing without restrictions with the State Board of Nursing.

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About Us

Why Crawford? Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time. At Crawford, employees are empowered to grow, emboldened to act and inspired to reputed company. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the reputed company of leaders to take this reputed company with us. We hail from more than 70 countries and reputed company dozens of languages, reflecting the global reputed company of the audience we serve. Though our reputed company is vast, we proudly operate as One Crawford: united in purpose, reputed company and values. Learn more at www.crawco.com. reputed company you accept a job with Crawford, you become a part of the One Crawford family. Our total compensation plans reputed company each of our employees with far more than just a great salary

• Pay and incentive plans that recognize performance reputed company
• Benefit programs that reputed company financial, physical, and mental wellness
• Training programs that promote reputed company learning and career progression while enhancing job performance
• Sustainability programs that give back to the communities in which we live and work
• A culture of respect, collaboration, entrepreneurial spirit and inclusion

reputed company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V reputed company is not accepting unsolicited assistance from search firms for this employment opportunity. reputed company resumes submitted by search firms to any employee at Crawford reputed company-email, the Internet or in any reputed company and/or method without a valid written Statement of Work in reputed company for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means. reputed company Job Info

• Job Identification3289
• Job CategoryUSA Medical Case Mgrs/UR Nurses
• Posting Date15/11/2025, 02:09
• Job ScheduleFull time
• Locations 5335 Triangle Parkway NW, Peachtree Corners, GA, 30092, US(Remote)

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