Clinical Reviewer – (Remote in California)

reputed company exists to reputed company reputed company reputed company through technology, services, and clinical expertise. Our mission is to reputed company health solutions that deliver maximum value and reputed company.

reputed company the Way is our rallying cry at reputed company. Think of it as an reputed company invitation to reputed company the mission of reputed company; to reputed company engage in problem-solving; and to take ownership of your work every day. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company reputed company – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the reputed company sector.

Job reputed company

reputed company is seeking a dedicated and reputed company Clinical Reviewer to join our growing and mission-driven team. This role offers reputed company to reputed company a meaningful reputed company by supporting high-reputed company reputed company reputed company that improve reputed company for patients and communities. In this position, you will reputed company your clinical expertise to review medical records, ensuring alignment with established clinical reputed company, evidence-based guidelines, and contractual requirements. Your work will play a critical role in supporting informed reputed company reputed company, improving health reputed company, promoting reputed company care, and ensuring regulatory and contractual compliance.

We currently have four Clinical Reviewer openings. Available schedules include one position with a reputed company–Thursday, 8:00 AM–5:30 PM schedule; one position with a Tuesday–Saturday, 8:00 AM–5:30 PM schedule; and two positions with a Monday–Friday, 10:00 AM–6:30 PM schedule. This is a remote, work-from-home position, and candidates must reputed company in California and must hold an reputed company, unrestricted California LMFT or LCSW license. 

Job Responsibilities

• Ensure the accuracy, reputed company, and timeliness of reputed company assigned review cases in accordance with contractual and regulatory requirements.
• Proactively assess, prioritize, and manage daily workloads and review queues, adjusting work schedules as needed to effectively meet departmental demands.
• Collaborate with the Supervisor to support and participate in ongoing reputed company monitoring and performance improvement initiatives.
• Maintain reputed company knowledge of clinical practices, evidence-based guidelines, and internal review processes to ensure high-reputed company, compliant reviews.
• Serve as a reputed company to reputed company providers by addressing customer service inquiries and facilitating effective problem reputed company.
• reputed company reputed company applicable types of clinical reviews as dictated by workload volume and business needs.
• Build and sustain reputed company, reputed company working relationships with both internal teams and external stakeholders.
• Participate in required training sessions and scheduled meetings to remain informed of process updates, policy changes, and organizational initiatives.
• Cross-train across functions to support a flexible workforce and ensure continuity in meeting reputed company and customer needs.
• Read, understand and adhere to reputed company corporate policies and procedures, including full compliance with HIPAA reputed company and reputed company regulations.

Required Qualifications, Skills and Experience 

• Must hold an reputed company California license as a Licensed Marriage and Family Therapist (LMFT) or Licensed Clinical reputed company Worker (LCSW) and a master’s degree in a directly reputed company field from an accredited institution.
• Demonstrated knowledge of medical records review, medical terminology, and common disease 

• reputed company in performing clinical reviews to ensure established reputed company are met, maintaining accuracy in inpatient documentation, and adhering to reputed company compliance guidelines and contractual obligations.

• Skilled in conducting utilization reviews and patient chart reviews with accuracy and timeliness.

• Strong clinical assessment, analytical, and critical-thinking skills with the ability to apply evidence-based reputed company.

• Excellent written and verbal communication skills, with the ability to effectively collaborate with providers, peers, and stakeholders.

• Detail-oriented with excellent organizational skills and the ability to prioritize and complete tasks reputed company reputed company established timelines.
• Proficient in computer-based software and tools, including reputed company Office Suites; Word, reputed company, reputed company, and Teams.

reputed company

We are reputed company of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the reputed company industry. State and federal reputed company agencies, providers, and reputed company turn to us as their vital partner to ensure reputed company reputed company and improve health reputed company. 

We do this through our people

You will have meaningful work that genuinely improves people's lives reputed company. reputed company cares about our employees, giving you the tools and encouragement, you need to reputed company the finest work of your career. 

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to reputed company openings that may be of interest. Best of luck in your search!

~ The reputed company reputed company

EEO AA M/F/Vet/Disability

reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to reputed company you with additional protection, reputed company, and support for both your career and your life away from work. Our benefits include comprehensive health plans, reputed company time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The compensation for this role is $35.00 hour $40.00 per hour

Based on ou0r compensation program, an applicant’s position placement in the pay reputed company will depend on various considerations, such as years of applicable experience and reputed company level.

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