Licensed Clinical Review Clinician
Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025
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Job Description:
A company is looking for a Clinical Review Clinician - Appeals -
Behavioral Health.
Key Responsibilities
Performs clinical reviews to resolve and process appeals by
analyzing medical records and clinical data
Ensures timely review and response to appeals in accordance with
State, Federal, and NCQA standards
Communicates with members, providers, and other departments
regarding appeals requests
Required Qualifications
Graduate from an Accredited School of Nursing or Bachelor's degree
in Nursing
2 - 4 years of related experience
Knowledge of NCQA, Medicare, and Medicaid regulations preferred
State Licensure as LPN, LVN, RN, LCSW, LMHC, LPC, LMFT, or Licensed
Psychologist required
For Health Net of California: RN license required
Keywords: VirtualVocations, Irvine , Licensed Clinical Review Clinician, Healthcare , Vista, California
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