A company is looking for a Lead Clinical Reviewer.
Key Responsibilities
Review medical records against criteria to determine medical appropriateness
Guide team members and support training and documentation efforts
Perform quality monitoring and audits to identify areas for improvement
Required Qualifications
Active and unrestricted Licensed Clinical Social Worker (LCSW) license for the state of Virginia
Master's degree from an accredited college in a relevant degree program
2+ years of experience in Prior Authorization, Utilization Review (UR), or Utilization Management (UM)
Clinical Reviewer • Sacramento, California, United States