Medical Utilization Review Specialist - Hybrid Role

The Beacon Mutual Insurance Company•Warwick, RI

3d•Hybrid

About The Position

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.

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

Responsibilities

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

Benefits

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