California RN Care Review Clinician

A company is looking for a Care Review Clinician specializing in Utilization Review. Key Responsibilities Assess services for members to ensure optimum outcomes and compliance with regulations Analyze clinical service requests against evidence-based clinical guidelines Conduct reviews to determine prior authorization and financial responsibility for treatments Required Qualifications At least 2 years of experience in hospital acute care, inpatient review, or managed care Active and unrestricted Registered Nurse (RN) license in California Ability to prioritize and manage multiple deadlines Proficiency in Microsoft Office and applicable software programs