California Licensed Clinical Reviewer

Job Summary

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
• Determine approval or initiate referrals to the physician consultant, processing decisions and providing detailed denials as needed
• Accurately abstract review-related data onto appropriate review tools and submit all administrative documents

Required Qualifications

• Active, unrestricted California license in LPCC, LCPC, LCMHC, LMHC, LMFT, or LCSW
• Master's degree from an accredited program in Social Work, Counseling, Psychology, or a related field
• 1+ years of experience with Medicaid, government-funded health plans, or hospital-based programs
• In-depth knowledge of the Mental Health Parity and Addiction Equity Act and related clinical standards
• Proficient in Microsoft Office Suite, including Excel, Word, PowerPoint, Teams, and Outlook