Description
The San Bernardino County, Department of Risk Management, is seeking proposals from qualified vendors to provide workers' compensation utilization review services. The selected vendor will be required to provide an effective utilization management program, ensuring that medical treatment provided to injured workers is appropriate, evidence-based, timely, and cost-effective. The program must comply with California Labor Code and utilize nationally accepted treatment guidelines. The vendor will be responsible for reviewing medical treatment requests, assessing medical reports, and ensuring confidentiality and delivery of utilization review decisions.
Key aspects of the scope of work include:
• Providing utilization review services in accordance with California Code of Regulations
• Establishing an electronic data link with the County's claims system provider
• Reviewing medical treatment requests for medical necessity, appropriateness, and duration of care
• Utilizing nationally accepted treatment guidelines
• Ensuring confidentiality and delivery of utilization review decisions
• Responding to County questions and correcting any problems that may arise
The contract period will be for a maximum of five years, beginning November 17, 2026, and ending November 16, 2031.