California Licensed Care Review Clinician - Portsmouth Virginia

Company: VirtualVocations
Location: Portsmouth, Virginia
Posted On: 01/15/2025

A company is looking for a Care Review Clinician (Remote California Licensed).
Key Responsibilities:

Serve as a clinical reviewer to determine if requests meet Continuity of Care or Community Support criteria
Provide concurrent review and prior authorizations as part of the Utilization Management team
Complete authorizations for medical services and collaborate with medical directors while following Utilization Management processes

Required Qualifications, Training, and Education:

3-5 years of clinical experience, ideally in both inpatient and outpatient settings
Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with an active, unrestricted California license
Familiarity with Utilization Management processes and medical necessity review tools
Knowledge of NCQA standards
Strong computer skills and proficiency in managing large volumes of data and tasks More...

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