Medical Utilization Review Specialist - Hybrid Role
The Beacon Mutual Insurance CompanyWarwick, RI
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Overview
Schedule
Flexible-schedule
Full-time
Career level
Senior-level
Remote
Hybrid remote
Benefits
Health Insurance
Life Insurance
Paid Vacation
Job Description
As a UM Specialist, you'll be at the center of medical review decisions-helping balance clinical appropriateness, regulatory standards, and excellent customer service. Your work will have a direct and meaningful impact on medical outcomes and day-to-day claim management, making this role both challenging and rewarding.
What you will do:
- Review requested inpatient and outpatient medical services to determine medical necessity and appropriateness
- Conduct prospective, retrospective, and concurrent utilization reviews
- Compare treatment requests against established medical protocols and guidelines
- Authorize compensable treatment plans in alignment with those standards
- Provide quality customer service while helping to expedite workflow
Requirements
- Associate's degree and three years of related experience, or an equivalent combination of education and experience
- Proficiency in medical terminology
- Working knowledge of spreadsheet software
- Ability to apply professional standards and protocols consistently and accurately
Why Join Beacon
- Competitive base salary along with a broad range of compensation initiatives
- Comprehensive health plans, life insurance and wellness programs
- Generous vacation time, plus telecommuting and flexible schedule arrangements
- Retirement savings plan and 401(k) educational programs
- Learning and development opportunities
- Friendly, inclusive, and supportive culture of caring and belonging
- Professional environment based on knowledge sharing and teamwork
- Work/Family Friendly, Hybrid role with 2 days in office and 3 days working from home
- Dedication to the health and wellness of our employees and a long standing winner of Worksite Wellness Awards
- Beacon is proud to be an EEO/AA Employer
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FAQs About Medical Utilization Review Specialist - Hybrid Role Jobs at The Beacon Mutual Insurance Company
What is the work location for this position at The Beacon Mutual Insurance Company?
This job at The Beacon Mutual Insurance Company is located in Warwick, RI, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at The Beacon Mutual Insurance Company?
Employer has not shared pay details for this role.
What employment applies to this position at The Beacon Mutual Insurance Company?
The Beacon Mutual Insurance Company lists this position under the following employment categories:
- Flexible-schedule
- Full-time
What experience level is required for this role at The Beacon Mutual Insurance Company?
The Beacon Mutual Insurance Company is looking for a candidate with "Senior-level" experience level.
What is the process to apply for this position at The Beacon Mutual Insurance Company?
You can apply for this role at The Beacon Mutual Insurance Company either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.