California Licensed Medical Reviewer

Job Summary

Seeking a California Licensed Medical Reviewer, the full-time remote Laboratory Specialist will review laboratory-related claims, Treatment Authorization Requests (TARs), and supporting documentation to ensure compliance with medical necessity and program requirements.

Key responsibilities

• Review laboratory-related claims, TARs, and orders for compliance with medical policies and program guidelines
• Evaluate the appropriateness of requested or billed laboratory services based on established criteria
• Document review findings and collaborate with clinical and operational teams to resolve laboratory review questions

Required qualifications

• Minimum of two years of experience as a laboratory technician
• High school diploma or equivalent
• Completion of a Medical Laboratory Technician program from an accredited institution
• Knowledge of laboratory procedures, terminology, and documentation
• Ability to interpret laboratory-related records and claims effectively