Florida Licensed Care Review Clinician

Job Summary

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

Key responsibilities

• Assess services for members to ensure optimum outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based clinical guidelines
• Conduct reviews for prior authorization and collaborate with medical directors as needed

Required qualifications

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