Care Review Clinician | Remote | California | Contract

Care Review Clinician I | Remote | Contract

Walker Healthforce is seeking a Care Review Clinician I with Health Plan or IPA prior authorization experience to perform medical necessity and utilization management reviews of healthcare services requiring prior authorization. This is a Contract opportunity.

Start Date: ASAP
Location: Remote – California
Approved Work Locations: California
Hours/Schedule: Schedule varies Sunday–Saturday, 6:00 AM–9:00 PM PST, 40 hours/week
Worker Type: W2

Core Requirements:

• Active California RN license
• Health Plan or IPA experience performing prior authorization review
• Medical necessity clinical review experience
• Experience analyzing clinical service requests against evidence-based clinical guidelines
• Experience reviewing benefits and eligibility for requested treatments and procedures
• Knowledge of utilization management and prior authorization processes
• Ability to process clinical reviews within required timelines

We Consider It A Bonus If You Also Have:

Job Responsibilities:

• Conduct medical necessity reviews for services requiring prior authorization
• Analyze clinical service requests against evidence-based guidelines
• Review member benefits and eligibility for requested treatments and procedures
• Process prior authorization requests within required timelines
• Refer appropriate requests to Medical Directors
• Obtain additional information from members and providers as necessary
• Make referrals to appropriate clinical programs
• Collaborate with multidisciplinary healthcare teams
• Maintain compliance with utilization management policies and applicable regulations

What We Offer:

• Competitive compensation package
• Weekly pay via Direct Deposit
• Medical, Dental & Vision available
• 401k options

Why Work With Walker?

• Access to our top ranked team of recruiting and placement specialists
• Continuous, one-on-one support from a dedicated engagement manager
• Professional resume development and interview preparation

Contact our Recruiting Team today to experience the Walker Healthforce difference!

About Us:

Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we're custom not commodity and we've been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!

We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment.