Clinical Care Reviewer – Utilization Management, Registered Nurse, Licensed Clinical Social Worker Or Behavioral Health - Remote Eligible

Clinical Care Reviewer

Join a mission-driven Utilization Management team where your clinical expertise helps shape better outcomes. We're hiring Clinical Care Reviewers across multiple specialties—medical and behavioral health—for roles that balance autonomy, clinical judgment, and meaningful collaboration. Lead with clinical insight. Whether you're an experienced utilization review nurse, a sharp case manager, or a behavioral health clinician ready to make an impact behind the scenes, this is your moment. As a Clinical Care Reviewer, you'll evaluate inpatient, outpatient, pediatric, or behavioral health services to ensure they align with clinical guidelines and regulatory standards. You'll apply your expertise to complex cases, collaborate with providers, and drive timely, well-informed care decisions that make a real difference. This isn't floor work—it's clinical leadership with purpose.

What You'll Do:

• Review inpatient, outpatient, and behavioral health service requests for medical necessity using InterQual and regulatory standards.
• Partner with families, providers, and internal teams to coordinate timely, effective care.
• Document clearly and consistently in EMR systems and meet quality and productivity metrics.
• Escalate complex cases for Medical Director review as needed.

We're Hiring for:

• General UM (RN): Mon–Fri, 8 AM–5:30 PM. Occasional evenings/weekends based on need.
• Pediatric Shift Care (RN): Mon–Fri, 8:30 AM–5 PM EST. Remote. Pediatric/home health experience preferred.
• Evening/Weekend UM (RN): Mon–Fri, 5 PM–12 AM + rotating Sat/Sun. Remote. Medicaid experience preferred.
• Behavioral Health UM (LPC, LCSW, LMHC, etc.): Mon–Fri, EST hours with limited holidays/weekends.

What You Bring:

• RN or independent BH license (LCSW, LPC, etc.) in good standing; compact licensure for RNs strongly preferred.
• 3+ years of clinical experience in ICU, ED, Med-Surg, pediatrics, behavioral health, or similar.
• Prior Utilization Management or managed care experience preferred.
• Strong analytical, communication, and time-management skills.
• EMR proficiency (e.g., JIVA, InterQual).

Why Us:

• 100% remote flexibility for most roles.
• Diverse opportunities under one streamlined application.
• Fast-paced, impactful work with a supportive team.
• Real potential to grow and make a difference.

Apply today to explore the opportunity that best fits your expertise—one application opens the door to multiple roles.