Clinical Review Coordinator Jobs
Clinical Review Coordinator jobs are open across health insurance, managed care, and hospital systems, with specializations in utilization management, prior authorization, and case review, from entry-level to senior coordinator roles. Scan the live roles below and apply to whichever ones fit.
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Showing 5 of 55+ Clinical Review Coordinator jobs
Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Key Details: Remote Role. Texas RN License Required.
- Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
- Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
- Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member
- Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
- Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
- Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines
- Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members
- Provides feedback on opportunities to improve the authorization review process for members
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.
Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
Knowledge of Medicare and Medicaid regulations preferred.
Knowledge of utilization management processes preferred.
License/Certification:
- For Superior Health Plan: RN license required
Pay Range: $27.02 - $48.55 per hour
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. 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 other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Key Details: Remote Role. Texas RN License Required.
- Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
- Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
- Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member
- Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
- Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
- Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines
- Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members
- Provides feedback on opportunities to improve the authorization review process for members
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.
Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
Knowledge of Medicare and Medicaid regulations preferred.
Knowledge of utilization management processes preferred.
License/Certification:
- For Superior Health Plan: RN license required
Pay Range: $27.02 - $48.55 per hour
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. 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 other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
Clinical Review Coordinator Jobs by Experience Level
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Who's Hiring
Top Industries Hiring
- Technology & Software
- Government & Public Sector
- Healthcare & Medical Services
- Insurance
- Consulting & Professional Services
What Employers Look For
The qualifications that appear most often in clinical review coordinator jobs.
- Active registered nurse, licensed clinical social worker, or equivalent clinical license
- Experience applying InterQual or MCG evidence-based clinical criteria
- Knowledge of utilization management, prior authorization, or case management processes
- Proficiency with electronic health records and payer-specific review platforms
- Familiarity with Medicare, Medicaid, or commercial insurance coverage guidelines
- Strong written documentation skills for denial letters and clinical rationale reports
Tips for Your Clinical Review Coordinator Job Search
Tailor your resume to utilization criteria
Highlight your experience applying InterQual or MCG criteria directly in your resume summary and job descriptions. Hiring managers scan for these by name, so listing them generically as 'clinical guidelines' puts you at a disadvantage against candidates who name the tools.
Get your CRC or CPUR certification first
Many postings list a Certified Rehabilitation Counselor or Certified Professional Utilization Reviewer credential as preferred or required. If you're a clinical licensee without one yet, completing the exam before applying meaningfully expands which roles you qualify for.
Apply early to roles that fit
Migrate Mate lists clinical review coordinator openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Filter by payer type before applying
Responsibilities differ sharply between commercial insurance payers, Medicare Advantage plans, and Medicaid managed care organizations. Reading the posting for the payer type helps you match your experience to the right environment and frame your cover letter with relevant terminology.
Prepare case scenarios for phone screens
Interviewers for clinical review roles routinely ask how you'd handle a denial recommendation when the treating physician disagrees. Walk through a real case you managed, covering the criteria you used, how you documented the decision, and how you communicated it to the clinical team.
Negotiate schedule flexibility during offer review
Many clinical review coordinator roles operate across time zones or cover weekend shifts for prior auth queues. During offer conversations, confirm shift expectations, on-call requirements, and whether you can adjust start times before accepting, since these details rarely appear in job postings.
Clinical Review Coordinator Jobs: Frequently Asked Questions
Which companies are hiring the most clinical review coordinators?
The most active employers for clinical review coordinators right now are Optum, Adventist Health, and UCLA Health, and the most openings are in California, Texas, and Minnesota, based on current listings on Migrate Mate as of November 2026. Managed care organizations and large regional health systems tend to post the highest volume of these roles year-round.
How many clinical review coordinator jobs are remote?
About 63% of clinical review coordinator openings are fully remote or hybrid as of November 2026, making this one of the more remote-accessible clinical roles available. Prior authorization review and utilization management work, which can be completed entirely through electronic health records and payer portals, accounts for the largest share of those remote listings.
How do you become a clinical review coordinator?
Start with an active clinical license, most commonly a registered nurse or licensed clinical social worker credential, since nearly all employers require one. Build hands-on experience in a hospital case management, discharge planning, or insurance utilization review setting. Learn to apply standardized clinical criteria such as InterQual or MCG, then pursue a utilization review certification to strengthen your candidacy for coordinator-level postings.
Can you get a clinical review coordinator job with little experience?
Yes, some entry-level clinical review coordinator postings accept candidates with a clinical license and limited direct utilization management experience, particularly at smaller regional health plans or third-party review organizations. Emphasize any exposure to insurance authorization, discharge planning, or electronic health record documentation in your application, and highlight completed coursework or self-study in utilization management guidelines to close the experience gap.
What does the clinical review coordinator interview process look like?
Most employers start with a recruiter phone screen focused on your clinical license, review platform experience, and availability. A second interview with a clinical manager typically includes scenario-based questions where you walk through how you'd document a denial or escalate a complex case. Some organizations add a brief written or practical assessment requiring you to apply criteria to a sample case before a final offer conversation.
Where can I find and apply to clinical review coordinator jobs?
You can find and apply to clinical review coordinator jobs on Migrate Mate, which lists current openings from across the United States. Search the roles available, find the ones that match your license type, specialty background, and preferred work setting, and apply directly to each listing that fits your situation.
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