Medical Utilization Review Specialist - Hybrid Role

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