Mid Level Clinical Reviewer Jobs
Mid level clinical reviewer jobs go to professionals ready to own case reviews end to end, apply independent clinical judgment, and guide less experienced colleagues without close oversight. Remote and hybrid opportunities are common, with hiring concentrated across Insurance, Non-Profit & Social Services, and Healthcare & Medical Services, where employers like Optum, North East Medical Services, and PRIME AE Group are competing for reviewers at this level now.
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The Licensed Psychologist, Peer Reviewer for Applied Behavior Analysis (ABA) Services evaluates requests for initial and continued coverage of ABA treatment and assessment services. The Peer Reviewer applies applicable clinical criteria, benefit-plan requirements, and federal, state, and local requirements; discusses clinically appropriate treatment considerations with treating providers; and issues clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.
Primary Responsibilities:
- Review initial and continued-service requests for ABA treatment and assessment services for commercial and Medicaid plans.
- Apply clinical criteria, benefit-plan requirements, and applicable federal, state, and local requirements to each review.
- Conduct peer-to-peer consultations and discuss clinically appropriate treatment considerations with treating providers.
- Compose and enter clear, timely clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.
- Review requests for single-case agreements and appeals of previously denied services.
- Participate in peer consultations, staff meetings, and training activities.
- Perform other duties as assigned.
- Licensed doctoral level Psychologist (Ph.D. or Psy.D.) Your license must be current, allow for full independent practice, and be unrestricted [You may be asked to obtain additional state licenses to meet growing business needs]
- 3+ years of post-licensure experience
- Clinical experience with Autism Spectrum Disorder
- Experience working with managed care entities
- Proficiency is MS Office Suite
- Ability to type proficiently, and for a significant portion of your day comfortably, while speaking on the phone
- Solid organizational and time-management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements and track multiple state and business nuances for the cases you review
- Ability to work well independently and collaborate with others on a clinical team
- Solid written and verbal communication and negotiation skills
- Thrive in a fast-paced environment
- Have a secure, private area of your home to set up an office, and access to a broadband ISP
- Available to work full-time during normal business hours Monday through Friday
- Ability and willingness to obtain additional state licenses based on business needs.
Preferred Qualifications:
- Psychologists licensed in AZ, CA, FL, GA, IN, KY, MA, MN, or MS
- BCBA, BCBA-D, LBA (in addition to being a licensed psychologist)
- APA accredited training and internship
- Applied Behavior Analysis training and/or experience
- Clinical experience with children and adolescents
- Experience working in a managed care setting
- Peer review experience with managed care
- Behavior Modification expertise
- Advanced computer skills using Excel and Access Databases
XJ6
The Licensed Psychologist, Peer Reviewer for Applied Behavior Analysis (ABA) Services evaluates requests for initial and continued coverage of ABA treatment and assessment services. The Peer Reviewer applies applicable clinical criteria, benefit-plan requirements, and federal, state, and local requirements; discusses clinically appropriate treatment considerations with treating providers; and issues clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.
Primary Responsibilities:
- Review initial and continued-service requests for ABA treatment and assessment services for commercial and Medicaid plans.
- Apply clinical criteria, benefit-plan requirements, and applicable federal, state, and local requirements to each review.
- Conduct peer-to-peer consultations and discuss clinically appropriate treatment considerations with treating providers.
- Compose and enter clear, timely clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.
- Review requests for single-case agreements and appeals of previously denied services.
- Participate in peer consultations, staff meetings, and training activities.
- Perform other duties as assigned.
- Licensed doctoral level Psychologist (Ph.D. or Psy.D.) Your license must be current, allow for full independent practice, and be unrestricted [You may be asked to obtain additional state licenses to meet growing business needs]
- 3+ years of post-licensure experience
- Clinical experience with Autism Spectrum Disorder
- Experience working with managed care entities
- Proficiency is MS Office Suite
- Ability to type proficiently, and for a significant portion of your day comfortably, while speaking on the phone
- Solid organizational and time-management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements and track multiple state and business nuances for the cases you review
- Ability to work well independently and collaborate with others on a clinical team
- Solid written and verbal communication and negotiation skills
- Thrive in a fast-paced environment
- Have a secure, private area of your home to set up an office, and access to a broadband ISP
- Available to work full-time during normal business hours Monday through Friday
- Ability and willingness to obtain additional state licenses based on business needs.
Preferred Qualifications:
- Psychologists licensed in AZ, CA, FL, GA, IN, KY, MA, MN, or MS
- BCBA, BCBA-D, LBA (in addition to being a licensed psychologist)
- APA accredited training and internship
- Applied Behavior Analysis training and/or experience
- Clinical experience with children and adolescents
- Experience working in a managed care setting
- Peer review experience with managed care
- Behavior Modification expertise
- Advanced computer skills using Excel and Access Databases
XJ6
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- Healthcare & Medical Services
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Mid Level Clinical Reviewer Jobs: Frequently Asked Questions
How do I get a mid level clinical reviewer job?
Position your experience around independent decision-making, not just task completion. Highlight cases or projects you owned from intake to resolution, any clinical guidelines or criteria sets you applied consistently, and situations where your judgment shaped an outcome. Applications that show scope of ownership and clinical reasoning, rather than volume of work alone, stand out at this level.
Which companies hire mid level clinical reviewers?
Companies hiring mid level clinical reviewers right now include Optum, North East Medical Services, and PRIME AE Group, based on current listings on Migrate Mate as of November 2026. At this level, hiring tends to come from managed care organizations, utilization management firms, and large health systems that need reviewers who can work independently on complex cases.
Are there remote mid level clinical reviewer jobs?
Yes, remote and hybrid availability is strong for clinical reviewers with solid independent experience. About 67% of mid level clinical reviewer openings are remote or hybrid as of November 2026, reflecting how thoroughly this work has shifted to distributed teams. Fully on-site roles are more common at smaller regional health plans and hospital-based utilization teams.
How do I move up to a mid level clinical reviewer role?
Moving from entry level into a mid level clinical reviewer role comes from consistently taking on more complex cases, reducing the need for supervisory sign-off, and demonstrating that your clinical reasoning holds up under scrutiny. Building familiarity with multiple review criteria frameworks, contributing to quality improvement projects, and showing measurable impact on outcomes or turnaround times all signal readiness for mid level scope.
Which industries hire the most mid level clinical reviewers?
Mid Level clinical reviewer roles concentrate in Insurance, Non-Profit & Social Services, and Healthcare & Medical Services, based on current listings on Migrate Mate as of November 2026. These sectors drive consistent demand because utilization management, prior authorization, and case management functions require experienced reviewers who can apply clinical criteria independently and handle higher-acuity decisions without constant escalation.