A utilization review entity shall ensure that all adverse determinations are made by a physician or licensed mental health professional. The physician or licensed mental health professional shall: 1. Possess a current and valid nonrestricted license in any United States jurisdiction;2. Have the appropriate training, knowledge, or expertise to apply appropriate clinical guidelines to the health care service being requested; and3. Make the adverse determination under the clinical direction of one of the utilization review entity's medical directors who is responsible for the provision of reviewing health care services to enrollees of Oklahoma. All such medical directors must be physicians licensed in any United States jurisdiction.Added by Laws 2024, c. 303, § 4, eff. Jan. 1, 2025.
Oklahoma Legal Code