California Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer - Behavioral Health.

Key Responsibilities

• Evaluate patient records to determine medical necessity and care appropriateness, ensuring compliance with service requirements
• Determine approval or initiate referrals to physician consultants, process decisions, and provide detailed denials as needed
• Continuously reassess review processes for improvement opportunities and maintain positive relationships with stakeholders

Required Qualifications

• Active, unrestricted California license as LPCC, LCPC, LCMHC, LMHC, LMFT, or LCSW
• Master's degree in Social Work, Counseling, Psychology, or a related behavioral health field
• 1+ years of experience with Medicaid, government-funded health plans, or hospital-based programs
• 1+ years evaluating patient records for medical necessity and care appropriateness
• In-depth knowledge of the Mental Health Parity and Addiction Equity Act and psychiatric disorders