Clinical Case Review Jobs
Clinical Case Review jobs are open across health insurance, managed care, hospitals, and utilization management firms, from entry-level reviewer to senior and lead roles, with specializations in medical necessity review, appeals and grievances, and concurrent review. Find a role that fits from the openings below and apply directly.
Find Clinical Case Review JobsOverview
Showing 5 of 90+ Clinical Case Review jobs
Part time
Shift:
Day Shift
Description:
Reporting to the Manager Social Services, Social Services, this position coordinates utilization review service for defined patient populations across the acute care continuum. This includes discharge planning, utilization management, care coordination collaboration, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources.
Requirements
1. Current licensure as a Registered Nurse (RN) in the state of California is required.
2. Current American Heart Association (AHA) Healthcare Provider CPR card is preferred.
3. Degree from an accredited baccalaureate nursing program (BSN) is preferred.
4. Certified Case Manager (CCM) national certification is preferred.
5. InterQual training must be obtained within six (6) months of hire into position.
6. Previous experience in at least two (2) areas of clinical specialty in an acute care setting is required.
7. Excellent communication skills, critical thinking, creative problem-solving skills, and competent organizational and planning skills are required.
8. The incumbent must be self-directed and able to tolerate frequent interruptions with a demanding workload.
9. Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system is preferred.
Pay Range
$49.47 - $71.74
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Part time
Shift:
Day Shift
Description:
Reporting to the Manager Social Services, Social Services, this position coordinates utilization review service for defined patient populations across the acute care continuum. This includes discharge planning, utilization management, care coordination collaboration, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources.
Requirements
1. Current licensure as a Registered Nurse (RN) in the state of California is required.
2. Current American Heart Association (AHA) Healthcare Provider CPR card is preferred.
3. Degree from an accredited baccalaureate nursing program (BSN) is preferred.
4. Certified Case Manager (CCM) national certification is preferred.
5. InterQual training must be obtained within six (6) months of hire into position.
6. Previous experience in at least two (2) areas of clinical specialty in an acute care setting is required.
7. Excellent communication skills, critical thinking, creative problem-solving skills, and competent organizational and planning skills are required.
8. The incumbent must be self-directed and able to tolerate frequent interruptions with a demanding workload.
9. Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system is preferred.
Pay Range
$49.47 - $71.74
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Clinical Case Review Jobs by Experience Level
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Find Clinical Case Review JobsClinical Case Review Job Market
Who's Hiring
- American Traveler48A
- Kern Medical3
- Baptist Health South Florida3
- JPS Health Network2J
- Memorial Healthcare System2
Top Industries Hiring
- Healthcare & Medical Services
What Employers Look For
The qualifications that appear most often in clinical case review jobs.
- Active RN or licensed clinical professional credential with current state licensure
- Experience applying InterQual or MCG clinical criteria for medical necessity determinations
- Minimum two years of acute care, managed care, or utilization management experience
- Familiarity with payer guidelines, CMS regulations, and coverage determination standards
- Proficiency with electronic health record systems and case management platforms
- Strong written communication skills for producing defensible, compliant review documentation
Tips for Your Clinical Case Review Job Search
Tailor your resume to UR criteria
Hiring managers for clinical case review roles scan for InterQual or MCG criteria experience before anything else. Name the specific criteria sets you've used, the clinical settings you applied them in, and whether your reviews were prospective, concurrent, or retrospective.
Highlight your licensure and specialty clearly
Many postings filter by licensure type before a human reads your resume. Put your RN, LCSW, or other active license and state of issue near the top. If you hold licensure in multiple states, list each one so you don't get screened out of remote roles unnecessarily.
Apply early to roles that fit
Migrate Mate lists clinical case review openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Filter openings by review type first
Utilization management, appeals, peer-to-peer facilitation, and quality improvement reviews require different daily workflows. Before applying, confirm which review type the role centers on so your cover letter can speak directly to that workflow and avoid a mismatch at the interview stage.
Prepare a peer-to-peer scenario for interviews
Interviewers routinely ask how you handle a physician who pushes back on a denial. Prepare a specific, de-identified example where you communicated a determination professionally and reached a documented resolution. Vague answers about staying calm rarely satisfy clinical case review hiring panels.
Negotiate remote arrangements before accepting
Remote and hybrid clinical case review roles often have state-of-licensure restrictions built into the offer. Clarify which states you're authorized to review cases for, whether the arrangement is permanent or subject to change, and whether you'll be expected to travel for audits or team meetings.
Clinical Case Review Jobs: Frequently Asked Questions
Which companies are hiring the most clinical case reviews?
The companies hiring the most clinical case reviews right now include American Traveler, Kern Medical, and Baptist Health South Florida, with the largest share of openings in California, Florida, and Virginia, based on current listings on Migrate Mate as of August 2026. Health insurance carriers and large managed care organizations consistently account for the majority of postings.
How many clinical case review jobs are remote?
About 31% of clinical case review openings are fully remote or hybrid as of August 2026, making it one of the more remote-accessible clinical roles available. Utilization management and appeals review positions are the sub-areas most frequently posted as fully remote, while concurrent review roles tied to inpatient settings tend to require on-site or hybrid arrangements.
How do you become a clinical case review?
Start by earning an active clinical license, most commonly as a registered nurse or licensed social worker, alongside direct patient care experience in an acute or post-acute setting. From there, build familiarity with InterQual or MCG criteria, either through employer training or self-study. Pursue a case management certification such as CCM or CPUR to strengthen your candidacy, then target entry-level utilization review or case management roles that provide structured review experience before moving into dedicated clinical case review positions.
Can you get a clinical case review job with limited experience?
Yes, some employers hire clinicians into clinical case review with as little as one year of direct patient care experience, particularly for roles focused on specific service lines where your clinical background is a direct match. Strengthening your application with demonstrated knowledge of payer processes, coverage criteria, or discharge planning significantly offsets a shorter work history. Entry-level utilization review coordinator roles are the most practical starting point and often lead directly into case review responsibilities.
What does the clinical case review interview process look like?
Most clinical case review interviews include an initial recruiter screen focused on licensure and criteria experience, followed by a structured panel or one-on-one interview with a clinical supervisor or medical director. You'll typically be asked to walk through a real or hypothetical case determination, explain your rationale against established criteria, and describe how you handle physician disagreements. Some employers add a written or scenario-based assessment before making an offer.
Where can I find and apply to clinical case review jobs?
You can find and apply to clinical case review jobs on Migrate Mate, which lists current openings from across the United States. Search the listings to find roles that match your licensure, specialty, and preferred work arrangement, then apply directly to each position that fits.
See All 90 Clinical Case Review Jobs
Find roles that match your experience and apply in just a few clicks.
Find Clinical Case Review Jobs