Virginia Licensed Clinical Reviewer

Job Summary

To support a growing team, the full-time Virginia Licensed Clinical Reviewer will review medical records for behavioral health against established criteria, ensuring accuracy and compliance while working remotely within the United States during Eastern time zone hours.

Key responsibilities:

• Assures accuracy and timeliness of review cases in accordance with contract requirements
• Evaluates daily workload and adjusts schedules to meet departmental demands
• Collaborates with supervisors on quality monitoring and identifies areas for improvement

Required qualifications:

• Active and unrestricted Virginia RN license or LMHP credentials
• Associate's degree or higher in a related field from an accredited institution
• Minimum of 1 year of experience in Prior Authorization, Utilization Review, or Utilization Management
• At least 3 years of direct clinical experience or applicable state clinical experience
• Availability to work weekends if needed, with advance notice provided