California Licensed Clinical Reviewer

A company is looking for a Clinical Reviewer - Behavioral Health (Remote within California). Key Responsibilities Evaluate patient records to determine medical necessity and care appropriateness, ensuring compliance with service requirements Determine approval or initiate referrals to physician consultants, process decisions, and provide detailed denials as needed Continuously reassess review processes for improvement opportunities and maintain positive relationships with stakeholders Required Qualifications Active, unrestricted California license as LPCC, LCPC, LCMHC, LMHC, LMFT, or LCSW Master's degree in Social Work, Counseling, Psychology, or a related behavioral health field 1+ years of experience with Medicaid, government-funded health plans, or hospital-based programs 1+ years evaluating patient records for medical necessity and care appropriateness In-depth knowledge of the Mental Health Parity and Addiction Equity Act and psychiatric disorders

Jun 12, 2025 - 01:40

A company is looking for a Clinical Reviewer - Behavioral Health (Remote within California). Key Responsibilities Evaluate patient records to determine medical necessity and care appropriateness, ensuring compliance with service requirements Determine approval or initiate referrals to physician consultants, process decisions, and provide detailed denials as needed Continuously reassess review processes for improvement opportunities and maintain positive relationships with stakeholders Required Qualifications Active, unrestricted California license as LPCC, LCPC, LCMHC, LMHC, LMFT, or LCSW Master's degree in Social Work, Counseling, Psychology, or a related behavioral health field 1+ years of experience with Medicaid, government-funded health plans, or hospital-based programs 1+ years evaluating patient records for medical necessity and care appropriateness In-depth knowledge of the Mental Health Parity and Addiction Equity Act and psychiatric disorders