California Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer, Nurse.

Key Responsibilities

• Evaluate cases that do not pass the authorization approval process while collaborating with call center staff
• Review charts and analyze clinical documentation to approve services meeting clinical review criteria
• Monitor quality of care standards and communicate with medical office staff regarding approvals and denials

Required Qualifications

• Current, unrestricted state licensure as a Registered Nurse
• California or Oregon License required
• Associate or Bachelor's degree in Nursing (must be a Registered Nurse)
• Minimum of 30 hours/week availability
• 5+ years clinical experience preferred