California Licensed Clinical Reviewer

A company is looking for a Utilization Management Clinical Reviewer. Key Responsibilities Independently manage review of cases for extended authorization Apply internal policies and medical necessity criteria to individual cases Coordinate internal appeals and collaborate on complex cases and utilization trends Required Qualifications Independent mental health clinical licensure (e.g. LCSW, LPC, LPCC, or LMFT) Experience with reviewing behavioral health documentation and familiarity with medical necessity criteria Knowledge and experience with EMR systems required Familiarity with HIPAA privacy requirements for patient information A passion for living the company's mission and values

Apr 19, 2025 - 02:34

A company is looking for a Utilization Management Clinical Reviewer. Key Responsibilities Independently manage review of cases for extended authorization Apply internal policies and medical necessity criteria to individual cases Coordinate internal appeals and collaborate on complex cases and utilization trends Required Qualifications Independent mental health clinical licensure (e.g. LCSW, LPC, LPCC, or LMFT) Experience with reviewing behavioral health documentation and familiarity with medical necessity criteria Knowledge and experience with EMR systems required Familiarity with HIPAA privacy requirements for patient information A passion for living the company's mission and values