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 (COC) or Community Support criteria
• Provide concurrent review and prior authorizations as part of the Utilization Management team
• Review inpatient and outpatient services to ensure cost-effectiveness and adherence to clinical standards

Required Qualifications:

• 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
• Strong computer skills and ability to manage large volumes of data
• Knowledge of regulatory guidelines and compliance standards related to managed care