California Licensed Care Review Clinician

Job Summary

A company is looking for a Care Review Clinician II (RN or LVN) Remote.

Key Responsibilities:

• Perform clinical reviews of service requests including concurrent and prior authorization determinations
• Serve as clinical support to the Continuity of Care (COC) and Community Support teams
• Utilize InterQual and other clinical guidelines to assess medical necessity and appropriate length of stay

Required Qualifications:

• Active, unrestricted LVN or RN license in California
• 3-5 years of clinical experience (inpatient, outpatient, or hospital setting strongly preferred)
• Prior experience in Utilization Management, Concurrent Review, or Prior Authorization
• Solid computer proficiency, including ability to toggle between multiple databases and tools
• Experience using InterQual or similar medical necessity criteria tools