New York Licensed Care Review Clinician

Job Summary

Working remotely, the full-time New York Licensed Care Review Clinician will assess clinical service requests, ensure compliance with regulations, and verify the medical necessity of services to support optimal member outcomes.

Key responsibilities

• Assess services for members to ensure compliance with state and federal regulations and guidelines
• Analyze clinical service requests against evidence-based clinical guidelines and determine prior authorization needs
• Collaborate with multidisciplinary teams to promote integrated care and refer cases to medical directors as necessary

Required qualifications

• At least 2 years of healthcare experience, including inpatient review or managed care
• Active and unrestricted clinical licensure in New York, if 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