Florida Licensed Care Review Clinician

Job Summary

To support clinical member services, the full-time Florida Licensed Care Review Clinician will assess medical necessity of services, analyze clinical requests, and ensure compliance with guidelines while working remotely.

Key responsibilities

• Assess services for members to ensure optimal outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based guidelines and determine prior authorization needs
• Collaborate with multidisciplinary teams to promote effective care delivery and manage referrals

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
• Proficiency in Microsoft Office and relevant software programs
• Ability to prioritize and manage multiple deadlines effectively
• Strong organizational and critical-thinking skills