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, analyze clinical guidelines, and collaborate with multidisciplinary teams to ensure quality care delivery.

Key responsibilities

• Assess services for members to ensure compliance with regulations and optimal outcomes
• 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 experience in hospital acute care, inpatient review, or managed care
• Active and unrestricted Registered Nurse (RN) license in the state of practice
• Proficiency in Microsoft Office and applicable software programs
• Ability to prioritize and manage multiple deadlines effectively
• Strong organizational and critical-thinking skills