Health Care Professional – Utilization Review / First-Level Reviewer

The Health Care Professional performs first-level utilization review of treatment authorization requests for injured workers using California's MTUS and evidence-based guidelines.

What You’ll Do

• Review Requests for Authorization and supporting medical documentation for completeness.
• Apply MTUS and other applicable evidence-based clinical guidelines.
• Determine whether sufficient clinical information is available and request additional information when necessary.
• Make first-level review determinations within regulatory timeframes.
• Approve treatment requests when criteria are satisfied.
• Communicate professionally with requesting providers.
• Prepare and refer cases that cannot be approved to a Physician Reviewer.
• Maintain accurate and timely documentation of utilization review activity.

Required Qualifications

• Active, unrestricted California professional license as an LVN, RN, or DC.
• Must reside and work in California.
• Clinical experience relevant to the licensed discipline.
• Strong clinical assessment, critical-thinking, analytical, and problem-solving skills.
• Proficiency with Microsoft Office and web-based platforms.
• Minimum typing speed of 45 WPM.

Schedule & Compensation

• Full-time, Monday–Friday during standard business hours
• Home-based/remote position within California
• Hourly rate: $42.00–$45.00 per hour