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.
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INTRODUCTION
Under the supervision of the Director of Social Services, the Clinical Case Manager in consultation with the Assistant Director of Social Services, works with diverse populations with multifaceted needs. Primary responsibilities include, but are not limited to, assisting clients in following through on established treatment plans, enhancing social functioning, and improving the client’s quality of life. The Clinical Case Manager serves as planner, advocate, broker, and record keeper for the client.
MAJOR DUTIES/ESSENTIAL FUNCTIONS
Essential and other important responsibilities and duties may include, but are not limited to the following:
- Initiates outreach to client population to educate clients on available social services assistance in order to increase patient compliance with medical treatment and social service case management plan.
- Utilizes strength-based, person-centered approach and motivational interviewing techniques to build rapport and engage clients into services to assist clients with addressing barriers to care.
- Develops a therapeutic working relationship with clients.
- Assesses clients for needs related to addictions, HIV/AIDS, mental illness, homelessness, domestic violence, pregnancy, family challenges, as well as other social determinants which impact health care.
- Assist clients to address social needs that impact their health care.
- Develops and maintains a person-centered case plan with the client to ensure services are responsive to individual client needs.
- Coach and support clients to increase their compliance with medical and behavioral health treatment.
- Provides advocacy, referral, and linkage to community resources and support networks to address identified needs, including assisting with health insurance enrollment.
- Provides regular follow up to all clients to ensure successful linkage to, and utilization of, community resources or in-house services.
- Provides crisis intervention as necessary.
- Coordinates with multi-disciplinary team at health center to share information regarding client’s status; provides problem solving with challenging patient situations.
- Accurately document all client encounters on appropriate social service forms; submits progress notes, encounter forms, etc. within established time frame.
- Assess for, and assist with insurance and other social services benefits as necessary.
- Provides counseling and psycho-educational groups as needed.
- Completes Psychosocial Assessments as necessary.
- Works with team and providers to complete Medical Summary Reports for benefits as necessary.
- Conducts mental status exams as necessary (based on licensure level).
- Provides brief therapy and solution focused therapy, as it relates to medical care and accessing services (based on licensure level).
- Participates in case conferencing as necessary.
- Train peers and health center staff as needed.
- Participate in Continuing Education to maintain license and professional standards.
- Abide by Code of Ethics for related discipline.
- Maintain professional relationship and appropriate boundaries with clients.
- Participates in professional development opportunities and regular supervision.
- Attends regular departmental, health center, agency meetings, activities, and events.
- Performs other duties as assigned.
MINIMUM QUALIFICATIONS
- Masters’ degree in social work, psychology, or other Human Services related field.
- For social workers, social work licensure in the District of Columbia required (LGSW or LICSW).
- For professional counseling, professional counseling licensure in the District of Columbia required (LGPC or LPC).
- Two (2) years of post-Master’s experience.
- Four (4) years of working in a community health or social service setting.
- Case management experience.
- Experience working with vulnerable and at-risk populations.
REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES
- Obtain SOAR certification within 90 days of hire.
- Strong oral and written communication skills required.
- Ability to type, and use electronic health records software program required.
- Knowledge of community resources a plus.
- FBI Fingerprinting and MPD local background check required for position.
- Good interpersonal skills required.
- Knowledge of social services, human behavior, psychopathology, and DSM.
- Work experience with a challenging population preferred.
- Must be a skillful interviewer, able to ask questions and effectively use interview skills to elicit needed information from clients.
- Must be a skillful listener, able to understand the meaning of client's statements.
- Must be a skillful observer, able to record the client's behavior and needs.
- Must be a skillful negotiator, able to reach definitive agreements with clients and service providers.
- Must be able to work well with interdisciplinary teams.
- Ability to prioritize and problem solve to maintain a case load.
- Strong organizational skills.
- Proficient in most products of Office 365 (Word, Excel, Power Point and Teams).
INTRODUCTION
Under the supervision of the Director of Social Services, the Clinical Case Manager in consultation with the Assistant Director of Social Services, works with diverse populations with multifaceted needs. Primary responsibilities include, but are not limited to, assisting clients in following through on established treatment plans, enhancing social functioning, and improving the client’s quality of life. The Clinical Case Manager serves as planner, advocate, broker, and record keeper for the client.
MAJOR DUTIES/ESSENTIAL FUNCTIONS
Essential and other important responsibilities and duties may include, but are not limited to the following:
- Initiates outreach to client population to educate clients on available social services assistance in order to increase patient compliance with medical treatment and social service case management plan.
- Utilizes strength-based, person-centered approach and motivational interviewing techniques to build rapport and engage clients into services to assist clients with addressing barriers to care.
- Develops a therapeutic working relationship with clients.
- Assesses clients for needs related to addictions, HIV/AIDS, mental illness, homelessness, domestic violence, pregnancy, family challenges, as well as other social determinants which impact health care.
- Assist clients to address social needs that impact their health care.
- Develops and maintains a person-centered case plan with the client to ensure services are responsive to individual client needs.
- Coach and support clients to increase their compliance with medical and behavioral health treatment.
- Provides advocacy, referral, and linkage to community resources and support networks to address identified needs, including assisting with health insurance enrollment.
- Provides regular follow up to all clients to ensure successful linkage to, and utilization of, community resources or in-house services.
- Provides crisis intervention as necessary.
- Coordinates with multi-disciplinary team at health center to share information regarding client’s status; provides problem solving with challenging patient situations.
- Accurately document all client encounters on appropriate social service forms; submits progress notes, encounter forms, etc. within established time frame.
- Assess for, and assist with insurance and other social services benefits as necessary.
- Provides counseling and psycho-educational groups as needed.
- Completes Psychosocial Assessments as necessary.
- Works with team and providers to complete Medical Summary Reports for benefits as necessary.
- Conducts mental status exams as necessary (based on licensure level).
- Provides brief therapy and solution focused therapy, as it relates to medical care and accessing services (based on licensure level).
- Participates in case conferencing as necessary.
- Train peers and health center staff as needed.
- Participate in Continuing Education to maintain license and professional standards.
- Abide by Code of Ethics for related discipline.
- Maintain professional relationship and appropriate boundaries with clients.
- Participates in professional development opportunities and regular supervision.
- Attends regular departmental, health center, agency meetings, activities, and events.
- Performs other duties as assigned.
MINIMUM QUALIFICATIONS
- Masters’ degree in social work, psychology, or other Human Services related field.
- For social workers, social work licensure in the District of Columbia required (LGSW or LICSW).
- For professional counseling, professional counseling licensure in the District of Columbia required (LGPC or LPC).
- Two (2) years of post-Master’s experience.
- Four (4) years of working in a community health or social service setting.
- Case management experience.
- Experience working with vulnerable and at-risk populations.
REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES
- Obtain SOAR certification within 90 days of hire.
- Strong oral and written communication skills required.
- Ability to type, and use electronic health records software program required.
- Knowledge of community resources a plus.
- FBI Fingerprinting and MPD local background check required for position.
- Good interpersonal skills required.
- Knowledge of social services, human behavior, psychopathology, and DSM.
- Work experience with a challenging population preferred.
- Must be a skillful interviewer, able to ask questions and effectively use interview skills to elicit needed information from clients.
- Must be a skillful listener, able to understand the meaning of client's statements.
- Must be a skillful observer, able to record the client's behavior and needs.
- Must be a skillful negotiator, able to reach definitive agreements with clients and service providers.
- Must be able to work well with interdisciplinary teams.
- Ability to prioritize and problem solve to maintain a case load.
- Strong organizational skills.
- Proficient in most products of Office 365 (Word, Excel, Power Point and Teams).
See All 81+ Clinical Case Review Jobs
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Find Clinical Case Review JobsClinical Case Review Job Market
A snapshot from current openings nationwide, updated as new roles post.
Who's Hiring
- CorVel Corporation16
- Clinica Sierra Vista7
- Children's Healthcare of Atlanta4
- Kindred Hospitals4
- AmTrust Financial Services3
Top Industries Hiring
- Healthcare & Medical Services45
- Technology & Software14
- Education8
- Insurance6
- Science & Research2
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 CorVel Corporation, Clinica Sierra Vista, and Children's Healthcare of Atlanta, with the largest share of openings in California, Georgia, and Texas, based on current listings on Migrate Mate as of June 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 28% of clinical case review openings are fully remote or hybrid as of June 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 81+ Clinical Case Review Jobs
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