Florida Licensed Care Review Clinician

Job Summary

Providing support for member clinical service review processes, the full-time Florida Licensed Care Review Clinician will assess behavioral health services for medical necessity, analyze clinical requests against guidelines, and collaborate with multidisciplinary teams in a remote environment.

Key responsibilities

• Assess services for members to ensure optimum outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based guidelines and determine prior authorization needs
• Collaborate with teams to promote care models and may approve requests for behavioral health therapy services

Required qualifications

• At least 2 years of healthcare experience, including behavioral health or hospital acute care
• Active and unrestricted licensure as an LCSW, LMSW, LPC, LPCC, or LMFT in Florida
• Demonstrated knowledge of community resources and ability to work with diverse populations
• Proven ability to work independently and manage multiple projects effectively
• Proficiency in Microsoft Office and applicable software programs