Florida Licensed Care Review Clinician

Job Summary

Florida Licensed Care Review Clinician, responsible for assessing clinical member services and ensuring compliance with medical necessity and guidelines in a full-time remote position.

Key Responsibilities

• Assess services for members to ensure compliance with regulations and optimize outcomes
• Analyze clinical service requests against evidence-based guidelines and determine prior authorization needs
• Collaborate with multidisciplinary teams and adhere to utilization management policies

Required Qualifications

• Active and unrestricted Registered Nurse (RN) license in Florida
• At least 2 years of experience in hospital acute care, inpatient review, or managed care
• Ability to prioritize and manage multiple deadlines
• Proficiency in Microsoft Office and applicable software programs