03/09/2026
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...
Beacon Mutual
Warwick, RI, USA
Full Time
