California Licensed Clinical Reviewer

Job Summary

A company is looking for a Utilization Clinical Reviewer to evaluate medical records and assess the medical necessity of psychiatric inpatient care.

Key Responsibilities

• Review and interpret patient records to determine medical necessity and care appropriateness
• Determine approval or initiate referrals, process decisions, and provide detailed denials as needed
• Abstract review-related data and submit all administrative documents to relevant parties

Required Qualifications

• Minimum of 2 years of experience with Medicaid or government-funded health plans
• Active, unrestricted California license in LCSW, LMFT, LPCC, or LCPC
• Master's degree in Social Work, Counseling, Psychology, or a related field
• In-depth knowledge of the Mental Health Parity and Addiction Equity Act
• Strong understanding of psychiatric disorders and clinical standards related to Level of Care determinations