Clinical Care Reviewer

Accountabilities: Provide one-on-one coaching and guidance to clinicians to support efficient, effective, and clinically appropriate care. Lead consultation sessions and educational groups focused on clinical practices, treatment planning, and care quality. Respond to provider questions by email, offering clear, respectful, and actionable guidance. Support Continued Care Review activities by reviewing clinical records, treatment progress, and documentation to help determine appropriate next steps in care. Apply clinical documentation standards and medical necessity criteria when reviewing treatment plans and care progression. Build collaborative relationships with providers and support their understanding of clinical quality expectations. Gather provider feedback and identify challenges, opportunities, and areas for improvement in care efficiency initiatives. Share structured observations and recommendations to help refine pilots, programs, and clinical workflows. Contribute to initiatives that improve care delivery at both the individual patient and broader population levels. Requirements: Master's degree in a relevant clinical discipline. Active, unrestricted clinical license, such as LCSW, LMFT, LPC, or an equivalent credential. At least 3 years of post-licensure experience in behavioral health. Experience reviewing clinical documentation and applying medical necessity criteria. Strong understanding of behavioral health treatment planning, treatment progression, and appropriate episode duration. Previous experience coaching, training, supervising, or providing feedback to clinicians, including facilitating consultation or educational groups. Excellent written communication skills, particularly the ability to respond to clinician inquiries clearly, respectfully, and efficiently. Comfort using electronic health records (EHRs) and digital tools such as Google Workspace and Salesforce. Preferred Qualifications: Experience in utilization management, peer review, or clinical quality. Familiarity with health plans, managed care organizations, or value-based care programs. At least 1 year of experience in a high-growth startup environment. Experience with measurement-informed care and using data, including outcome measures and utilization trends, to guide clinical decisions and provider coaching. Experience implementing new programs, pilots, or initiatives in evolving environments and providing structured feedback for continuous improvement. Experience using AI tools, or openness to adopting them, to improve clinical review and provider communication workflows. Availability aligned with Mountain Standard Time (MST) or Pacific Standard Time (PST) is preferred. Benefits: Base salary: $91,000–$106,400 USD. The stated range represents starting total cash and does not include a bonus. Offers are based on experience, proficiency, and pay equity. Equity opportunities. Fully remote work environment for employees based in the United States; hiring is currently not available in Hawaii. Flexible working hours designed to support work-life balance. Comprehensive medical, dental, vision, life, and disability insurance. Flexible Spending Account (FSA) and Health Savings Account (HSA) options. Access to a 401(k) retirement savings plan. Generous paid time off, including two company-wide shutdown weeks annually for most employees. Paid parental leave for birthing, non-birthing, adoptive, and foster parents. Employee Assistance Program (EAP) and mental health resources. New-hire home office stipend and a $50 monthly internet or cell phone stipend. $50 monthly wellness stipend and year-round wellness initiatives. Quarterly department stipend for team-building activities and in-person gatherings. Employee resource groups and opportunities to connect with colleagues across different backgrounds and experiences.