Clinical Care Reviewer

We are seeking a Clinical Care Reviewer to support Rula’s Clinical Quality team by reviewing clinical documentation and treatment trajectory to ensure care meets medical necessity standards.

Requirements

• Master’s degree and active, unencumbered clinical license (LCSW, LMFT, LPC, or equivalent)
• 3+ years of post-licensure experience in behavioral health
• Expertise reviewing clinical documentation and applying medical necessity criteria
• Strong knowledge of behavioral health treatment planning, progression, and appropriate care episode duration
• Excellent written communication and ability to clearly convey clinical findings and recommendations to clinical and non-clinical audiences
• Proficiency working with EHRs and digital tools (e.g., Google Workspace, Salesforce)
• Experience in utilization management, peer review, or clinical quality roles
• Experience working with or for health plans or managed care organizations (e.g., Kaiser Permanente)
• 1+ years of experience in a high-growth and/or start-up environment
• Hands on proficiency working with data (e.g., outcomes measures, utilization trends) to inform clinical decisions
• Deep experience with process improvement and building scalable clinical workflows
• Comfort using or openness to using AI tools to improve operational efficiency and support clinical review workflows at scale

Benefits

• 100% remote work environment
• Attractive pay and benefits
• Comprehensive health benefits
• 401(k) plan access
• Generous time-off policies
• Paid parental leave
• Employee Assistance Program (EAP)
• New hire home office stipend
• Quarterly department stipend
• Wellness events and lunch & learns
• Community and employee resource groups

Originally posted on Himalayas