California Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer to join their team remotely in California.

Key Responsibilities

• Ensure the accuracy, quality, and timeliness of all assigned review cases in accordance with contractual and regulatory requirements
• Proactively assess, prioritize, and manage daily workloads and review queues to meet departmental demands
• Collaborate with the Supervisor to support ongoing quality monitoring and performance improvement initiatives

Required Qualifications, Training, and Education

• Must hold an active California license as a Licensed Marriage and Family Therapist (LMFT) or Licensed Clinical Social Worker (LCSW) and a master's degree in a related field
• Demonstrated knowledge of medical records review, medical terminology, and common diseases
• Experienced in performing clinical reviews to ensure compliance with established criteria
• Skilled in conducting utilization reviews and patient chart reviews accurately and timely
• Proficient in computer-based software and tools, including Microsoft Office Suite