California Licensed Medical Reviewer

Job Summary

Providing subject-matter expertise in a remote full-time capacity, the California Licensed Medical Reviewer (Speech and Audiology Specialist) will review speech, language, and audiology-related claims, Treatment Authorization Requests (TARs), and clinical documentation to ensure compliance with medical necessity and coverage requirements.

Key responsibilities

• Review speech, language, and audiology-related claims and clinical documentation for medical necessity
• Evaluate requested services based on medical policies and professional standards
• Collaborate with clinical specialists and operations teams to resolve review questions and document findings

Required qualifications

• Minimum of three (3) years of experience as a Speech, Language, or Audiology practitioner
• Current California professional credentials applicable to the discipline
• Current Certificate of Clinical Competence in Speech-Language Pathology or Audiology from the American Speech-Language-Hearing Association
• Strong clinical judgment and ability to interpret clinical records and treatment plans
• Ability to work independently while collaborating with cross-functional teams