California Licensed Medical Reviewer
Job Summary
Supporting Medical Review Services for California healthcare programs, the full-time California Licensed Medical Reviewer will utilize professional nursing experience to review medical records, healthcare services, claims, and authorization requests in a remote work environment.
Key responsibilities
- Review and interpret medical records to assess medical necessity and appropriateness of healthcare services
- Provide clinical review support for Treatment Authorization Requests (TARs) and related authorization activities
- Document review findings and collaborate with healthcare professionals to ensure accurate medical review determinations
Required qualifications
- Active and unrestricted Registered Nurse (RN) license in California
- Minimum of two years of professional nursing experience
- Master's Degree in Nursing may substitute for one year of required experience
- Knowledge of professional nursing principles and hospital routines
- Experience with medical review, utilization review, or claims review preferred
Complete Job Description
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