Mid Level Medical Reviewer Jobs
Mid level medical reviewer jobs go to professionals ready to own end-to-end review processes, guide junior colleagues, and exercise independent clinical judgment with minimal oversight. Roles run across Insurance, Non-Profit & Social Services, and Healthcare & Medical Services, with a mix of on-site, remote, and hybrid settings, and employers like Optum, North East Medical Services, and PRIME AE Group hiring 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 Medical Reviewer Jobs: Frequently Asked Questions
How do I get a mid level medical reviewer job?
Position your experience around ownership, not just participation. Highlight cases where you independently reviewed complex documentation, identified risk, or made consequential clinical or regulatory judgments. Applications that show you have moved beyond task execution and into decision-making consistently stand out. Tailor your resume to the therapeutic area or review type the employer focuses on, and lead with measurable outcomes rather than responsibilities.
Which companies hire mid level medical reviewers?
Companies hiring mid level medical 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 pharmaceutical manufacturers, contract research organizations, health insurers, and regulatory affairs firms that need reviewers who can operate with autonomy on complex cases.
Are there remote mid level medical reviewer jobs?
Yes, and remote availability is notably strong at this level. About 67% of mid level medical reviewer openings are remote or hybrid as of November 2026, reflecting the documentation-heavy, independent nature of the work. Employers often extend remote options to experienced reviewers because the role depends on expertise and judgment rather than on-site collaboration.
How do I move up to a mid level medical reviewer role?
Moving into a mid level role typically means building a record of independent, accurate review work and taking on progressively more complex cases. Reviewers who grow into this level have usually deepened expertise in a specific therapeutic area, demonstrated ownership of review cycles without close supervision, and contributed to process improvements or quality outcomes that had measurable impact on their team or organization.
Which industries hire the most mid level medical reviewers?
Mid Level medical 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 hiring at this level because they handle high volumes of clinical documentation, regulatory submissions, or insurance claims that require reviewers capable of exercising consistent, defensible judgment with limited oversight.