Florida Licensed Care Review Clinician

Job Summary

To support clinical member services, the full-time Florida Licensed Care Review Clinician will assess medical necessity, verify compliance with clinical guidelines, and collaborate with multidisciplinary teams in a remote capacity.

Key responsibilities

• Assess services for members to ensure optimum outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based clinical guidelines and determine prior authorization needs
• Collaborate with medical directors and multidisciplinary teams to promote quality member care

Required qualifications

• At least 2 years of healthcare experience in areas such as 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
• Strong organizational skills with the ability to manage multiple deadlines
• Excellent problem-solving and critical-thinking abilities