California Licensed Care Review Clinician

Job Summary

A company is looking for a Care Review Clinician (Remote California Licensed).

Key Responsibilities:

• Serve as a clinical reviewer to determine if requests meet Continuity of Care or Community Support criteria
• Provide concurrent review and prior authorizations as part of the Utilization Management team
• Complete authorizations for medical services and collaborate with medical directors while following Utilization Management processes

Required Qualifications, Training, and Education:

• 3-5 years of clinical experience, ideally in both inpatient and outpatient settings
• Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with an active, unrestricted California license
• Familiarity with Utilization Management processes and medical necessity review tools
• Knowledge of NCQA standards
• Strong computer skills and proficiency in managing large volumes of data and tasks