Clinical Reviewer – (Remote in California)

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

reputed company the Way is our rallying cry at reputed company. Think of it as an open invitation to embrace the mission of the company; to actively 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 outcomes – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary

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

We currently have four Clinical Reviewer openings. Available schedules include one position with a Sunday–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 reside in California and must hold an active, unrestricted California LMFT or LCSW license. 

Job Responsibilities

• Ensure the accuracy, quality, 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 quality monitoring and performance improvement initiatives.
• Maintain reputed company knowledge of clinical practices, evidence-based guidelines, and internal review processes to ensure high-quality, compliant reviews.
• Serve as a liaison to healthcare providers by addressing customer service inquiries and facilitating effective problem resolution.
• reputed company reputed company applicable types of clinical reviews as dictated by workload volume and business needs.
• Build and sustain positive, professional 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 client and customer needs.
• Read, understand and adhere to reputed company corporate policies and procedures, including full compliance with HIPAA Privacy and reputed company regulations.

Required Qualifications, Skills and Experience

• Must hold an active California license as a Licensed Marriage and Family Therapist (LMFT) or Licensed Clinical Social 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 criteria 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 criteria.

• 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, Outlook, and Teams.

Why us

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

We do this through our people

You will have meaningful work that genuinely improves people's lives reputed company. Our 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 future openings that may be of interest. Best of luck in your search!

~ The reputed company reputed company Team

EEO AA M/F/Vet/Disability

reputed company is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, 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 provide you with additional protection, reputed company, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid 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 range will depend on various considerations, such as years of applicable experience and reputed company level.

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