Job Description

Clinical Reviewer

The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements. Position is remote however candidates must reside in California and they need to have an active California license as a LCSW OR LMFT OR LPCC OR Licensed Social Worker.

Duties & Responsibilities:

• Assures accuracy and timeliness of all applicable review type cases within contract requirements.
• Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
• In collaboration with Supervisor, responsible for quality monitoring activities.
• Maintains current knowledge base related to review processes and clinical practices.
• Functions as providers' liaison for customer service issues and problem resolution.
• Performs all applicable review types as workload indicates.
• Fosters positive and professional relationships with internal and external customers.
• Attends training and scheduled meetings for current/updated information.
• Cross trains to provide flexible workforce to meet client/customer needs.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
• Knowledge of medical records, medical terminology, and disease processes required.
• Strong clinical assessment and critical thinking skills required.
• Excellent written and verbal communication skills required.

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