Florida Licensed Care Review Clinician

Job Summary

Providing essential clinical member services support, the full-time Florida Licensed Care Review Clinician will assess service requests to ensure medical necessity and compliance with clinical 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 adhere to utilization management policies

Required qualifications

• At least 2 years of healthcare experience in acute care, inpatient review, or managed care
• Active and unrestricted clinical licensure or certification as required by state regulations
• Proficiency in Microsoft Office suite and applicable software programs
• Ability to prioritize and manage multiple deadlines effectively
• Strong organizational, problem-solving, and critical-thinking skills