Clinical Reviewer Jobs
Clinical Reviewer jobs are open across health insurance, managed care, utilization management, and government health programs, at every level from entry-level to senior and lead, with specializations in utilization review, prior authorization, and case management. Find a role that fits below and apply directly.
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Showing 5 of 19+ Clinical Reviewer jobs
Job Description
A bit about this role:
A licensed dental hygienist will play a vital role within Devoted Health's Clinical Operations team by performing first-level clinical reviews of dental claims and pre-treatment estimates using established clinical guidelines, policies, and delegated authority. This position ensures accurate, timely, and compliant utilization management while supporting high-quality, compassionate care and strong relationships with dental providers.
Schedule: The position follows a five-day, eight-hour work schedule, totaling 40 hours per week. Shifts are scheduled within the hours of 8:00 AM–8:00 PM ET and will include weekend and Holiday rotation coverage.
Your Responsibilities and Impact will include:
- First-Level Clinical Evaluation: Review assigned dental claims and pre-treatment estimates requiring clinical evaluation, approving claims that meet clinical, contractual, and documentation requirements.
- Documentation & Image Review: Evaluate radiographs, dental charting, narratives, treatment records, and claim histories using evidence-based guidelines and clinical expertise.
- Case Referral & Coordination: Refer complex cases, potential denials, or adverse benefit determinations to Dental Advisors or designated clinical authorities for final determination (the Dental Hygienist Clinical Reviewer does not deny authorizations).
- Documentation & System Entry: Identify required documentation for clinical review, clear processing instructions, and document review findings accurately in claims systems.
- Coding & Policy Application: Consistently apply ADA CDT coding knowledge, dental terminology, clinical documentation standards, and contractual provisions.
- Quality & Escalation: Identify and escalate unusual practice patterns, utilization trends, potential fraud, waste, or abuse concerns, policy gaps, or workflow issues.
- Cross-Functional Collaboration: Collaborate with Dental Advisors, Claims, Provider Relations, and team leads to support smooth operations and constructive provider communications.
- Compliance: Maintain full compliance with HIPAA, privacy standards, organizational policies, and regulatory requirements.
Required skills and experience:
- 5+ years of clinical experience as a dental hygienist in a private practice or comparable dental healthcare setting. Dental claims review or utilization management experience is a plus.
- Active Registered Dental Hygienist (RDH) license or relevant clinical dental credential in good standing.
- Strong working knowledge of ADA CDT coding, dental terminology, dental procedures, and clinical documentation.
- Demonstrated ability to read and interpret dental radiographs, charting, clinical narratives, and treatment records.
- Excellent analytical, organizational, communication, and problem-solving skills with high attention to detail.
- Proficiency with claims-processing systems, electronic health/dental records, and standard digital tools.
- Experience with technology-enabled workflow improvements, particularly with AI/LLM tools.
Desired skills and experience:
- Prior experience in dental insurance claims review, utilization management, or health plan clinical operations, ideally within a Medicare Advantage or managed care setting.
#LI-remote
Salary range: $58,000 - $75,000 annually
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....
- Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
We have been made aware of instances of fraudulent job postings and/or fraudulent recruiting activity by individuals purporting to represent Devoted Health. These fraudulent schemes often seek monetary contributions or payments from job seekers (such as for “start up costs” or “equipment”), or seek to collect sensitive personal information. These job postings and offers are NOT authorized by Devoted Health and Devoted is not responsible for fraudulent offers, personal information that you may have disclosed, or payments made to third parties purporting to represent Devoted. We have reported this matter and are cooperating with law enforcement agencies. Devoted Health will never ask for financial commitment or contribution from a candidate at any stage of the recruitment process.
Job Description
A bit about this role:
A licensed dental hygienist will play a vital role within Devoted Health's Clinical Operations team by performing first-level clinical reviews of dental claims and pre-treatment estimates using established clinical guidelines, policies, and delegated authority. This position ensures accurate, timely, and compliant utilization management while supporting high-quality, compassionate care and strong relationships with dental providers.
Schedule: The position follows a five-day, eight-hour work schedule, totaling 40 hours per week. Shifts are scheduled within the hours of 8:00 AM–8:00 PM ET and will include weekend and Holiday rotation coverage.
Your Responsibilities and Impact will include:
- First-Level Clinical Evaluation: Review assigned dental claims and pre-treatment estimates requiring clinical evaluation, approving claims that meet clinical, contractual, and documentation requirements.
- Documentation & Image Review: Evaluate radiographs, dental charting, narratives, treatment records, and claim histories using evidence-based guidelines and clinical expertise.
- Case Referral & Coordination: Refer complex cases, potential denials, or adverse benefit determinations to Dental Advisors or designated clinical authorities for final determination (the Dental Hygienist Clinical Reviewer does not deny authorizations).
- Documentation & System Entry: Identify required documentation for clinical review, clear processing instructions, and document review findings accurately in claims systems.
- Coding & Policy Application: Consistently apply ADA CDT coding knowledge, dental terminology, clinical documentation standards, and contractual provisions.
- Quality & Escalation: Identify and escalate unusual practice patterns, utilization trends, potential fraud, waste, or abuse concerns, policy gaps, or workflow issues.
- Cross-Functional Collaboration: Collaborate with Dental Advisors, Claims, Provider Relations, and team leads to support smooth operations and constructive provider communications.
- Compliance: Maintain full compliance with HIPAA, privacy standards, organizational policies, and regulatory requirements.
Required skills and experience:
- 5+ years of clinical experience as a dental hygienist in a private practice or comparable dental healthcare setting. Dental claims review or utilization management experience is a plus.
- Active Registered Dental Hygienist (RDH) license or relevant clinical dental credential in good standing.
- Strong working knowledge of ADA CDT coding, dental terminology, dental procedures, and clinical documentation.
- Demonstrated ability to read and interpret dental radiographs, charting, clinical narratives, and treatment records.
- Excellent analytical, organizational, communication, and problem-solving skills with high attention to detail.
- Proficiency with claims-processing systems, electronic health/dental records, and standard digital tools.
- Experience with technology-enabled workflow improvements, particularly with AI/LLM tools.
Desired skills and experience:
- Prior experience in dental insurance claims review, utilization management, or health plan clinical operations, ideally within a Medicare Advantage or managed care setting.
#LI-remote
Salary range: $58,000 - $75,000 annually
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....
- Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
We have been made aware of instances of fraudulent job postings and/or fraudulent recruiting activity by individuals purporting to represent Devoted Health. These fraudulent schemes often seek monetary contributions or payments from job seekers (such as for “start up costs” or “equipment”), or seek to collect sensitive personal information. These job postings and offers are NOT authorized by Devoted Health and Devoted is not responsible for fraudulent offers, personal information that you may have disclosed, or payments made to third parties purporting to represent Devoted. We have reported this matter and are cooperating with law enforcement agencies. Devoted Health will never ask for financial commitment or contribution from a candidate at any stage of the recruitment process.
Clinical Reviewer Jobs by Experience Level
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Find Clinical Reviewer JobsClinical Reviewer Job Market
Who's Hiring
Top Industries Hiring
- Healthcare & Medical Services
What Employers Look For
The qualifications that appear most often in clinical reviewer jobs.
- Active RN, MD, or equivalent clinical license in good standing
- Minimum two years of direct patient care or acute care experience
- Working knowledge of InterQual or MCG clinical criteria
- Experience with utilization review, prior authorization, or case management
- Familiarity with ICD-10 coding and medical terminology
- Strong written communication skills for documenting clinical rationale
Tips for Your Clinical Reviewer Job Search
Tailor your resume to review criteria
Clinical reviewers are hired to apply evidence-based guidelines like InterQual or MCG, so name the specific criteria sets you've used on your resume. Hiring managers scan for these terms before reading anything else, and a generic clinical background won't stand out.
Highlight your licensure and active state
Many clinical reviewer roles require an active RN, MD, or other clinical license in a specific state. List your license type, number, and state clearly near the top of your resume so recruiters don't have to dig for it, especially if you hold multi-state compact licensure.
Apply early to roles that fit
Migrate Mate lists clinical reviewer openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Filter for utilization review versus case management openings
These two functions are often posted under the same job title but require different day-to-day skills. Read the job description closely to confirm whether the role focuses on authorization decisions, concurrent review, or longitudinal care coordination before you apply.
Prepare for scenario-based interview questions
Interviewers for clinical reviewer roles frequently present a patient scenario and ask how you would apply the relevant criteria to reach a coverage determination. Practice walking through a denial rationale out loud, citing the clinical basis and documentation you would need.
Negotiate for scope and caseload clarity
Before accepting an offer, ask about the daily review volume, the mix of inpatient versus outpatient cases, and the turnaround time expectations. These specifics vary widely across payers and directly affect workload, so get them in writing before you sign.
Clinical Reviewer Jobs: Frequently Asked Questions
Which companies are hiring the most clinical reviewers?
The companies hiring the most clinical reviewers right now include Dane Street, Optum, and AWG, with the largest share of openings in Arizona, Nevada, and Oregon, based on current listings on Migrate Mate as of November 2026. Health insurance carriers and managed care organizations account for the majority of active postings.
How many clinical reviewer jobs are remote?
About 69% of clinical reviewer openings are fully remote or hybrid as of November 2026, making this one of the more remote-accessible clinical roles available. Prior authorization and utilization review positions tend to be the most likely to offer fully remote arrangements, while case management roles more often require hybrid or in-person presence.
How do you become a clinical reviewer?
Start by earning an active clinical license, most commonly as a registered nurse, though some roles accept other licensed clinicians. Build at least two years of direct patient care experience, then familiarize yourself with evidence-based criteria sets like InterQual or MCG. Many employers offer internal training on their specific platform and payer policies once you are hired.
Can you get hired as a clinical reviewer with little experience?
Some entry-level clinical reviewer roles are open to newly licensed RNs, particularly in prior authorization or telephonic utilization review, where employers provide criteria training. Your chances improve significantly if you have acute care experience in a relevant specialty such as med-surg, orthopedics, or behavioral health, since reviewers often cover cases matching their clinical background.
What does the clinical reviewer interview process look like?
The process typically starts with a phone screen covering your license status, criteria experience, and comfort working independently. A video interview follows, often including a scenario-based question where you walk through a hypothetical case determination. Some employers add a short written exercise asking you to document a clinical rationale, and final-round conversations may involve the medical director.
Where can I find and apply to clinical reviewer jobs?
You can find and apply to clinical reviewer jobs on Migrate Mate, which lists current openings from across the United States in one place. Find roles that match your license, specialty, and preferred work arrangement, then apply directly to each listing that fits.
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