Top 77 Clinical reviewer Jobs in Florida

Psychologist Reviewer
BHM Healthcare Solutions —Tampa, FL
- $38 - $48 an hour
- Full-time
- Hybrid work
- Background check
- Writing skills
- Office
- Health insurance
- Dental insurance
Quick Apply
8d
Utilization Review Specialist (Remote)
The Florida House —Deerfield Beach, FL
- Per diem
- Remote
- Nursing
- Addiction Medicine
- Mid-level
- Continuing education credits
- Disability insurance
Quick Apply
8d
Second Level Reviewer I PRN Remote
AdventHealth Corporate —Altamonte Springs, FL
- $31.82 - $59.17 an hour
- PRN
- Remote
- Background check
- Nursing
- RN License
- Paid parental leave
- Disability insurance
Utilization Review Specialist
We Level Up —Pompano Beach, FL
- $50,000 - $90,000 a year
- Full-time
- Remote
- 18 years or older
- CPR Certification
- HIPAA
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DRG Nurse Reviewer Appeals and Hearings- Remote
Gainwell Technologies —Florida
- $95,000 - $110,000 a year
- Full-time
- Remote
- RN License
- Presentation skills
- Travel
- Health insurance
- Tuition reimbursement
Second Level Reviewer I
AdventHealth Corporate —Altamonte Springs, FL
- $66,170.74 - $123,073.07 a year
- Full-time
- Background check
- Nursing
- RN License
- Paid parental leave
- Disability insurance
Medical Reviewer
Medical Consultants Management LLC —Deerfield Beach, FL
- Bilingual
- Writing skills
- Clinic experience
- Paid holidays
- Health insurance
Quick Apply
Insurance Reviewer Clinical
Florida Cancer Affiliates —Ocala, FL
- HIPAA
- Research
- Mid-level
- Wellness program
- Disability insurance
2d
Clinical Documentation Integrity - Second Level Reviewer
University of Miami —Hialeah, FL
- Full-time
- Remote
- Nursing
- Medicine
- Microsoft Excel
- Health insurance
- Dental insurance
CLINICAL REVIEWER - MA - FULL TIME
WATSON CLINIC LLP —Lakeland, FL
- Full-time
- Clinic experience
- High school diploma or GED
- Communication skills
Quick Apply
9d
Physician Reviewer - Internal Medicine
Dane Street, LLC —West Palm Beach, FL
- Contract
- Remote
- Medicine
- Internal Medicine
- Mid-level
Quick Apply
OASIS Reviewer
Revival Home Health Care a Centers Company —Margate, FL
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Utilization Reviewer 2
Enlyte —Tampa, FL
- $59,500 - $76,000 a year
- Full-time
- RN License
- Mid-level
- Office
- Health savings account
- AD&D insurance
Utilization Management Rep I (contract)
Elevance Health —Tampa, FL
- Call employer
- Hybrid work
- High school diploma or GED
- US work authorization
- Data entry
- Health savings account
- Disability insurance
UTILIZATION REVIEWER
Larkin Community Hospital —South Miami, FL
- Full-time
- Spanish
- RN License
- English
14d
Utilization Management Reviewer
Mental Health Resource Center —Jacksonville, FL
- Full-time
- Background check
- Nursing
- Psychiatry
- Paid holidays
- Disability insurance
Quick Apply
RN Professional Practice Quality Reviewer (Full Time, Days)
Nicklaus Children's Hospital —Miami, FL
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Access
5d
Hospice Physician Audit Reviewer (Remote)
VITAS Healthcare —Miramar, FL
- Full-time
- Remote
- Senior level
- Hospice & Palliative Medicine
Quick Apply
16h
Intake RN
Centers Plan for Healthy Living —Margate, FL
- Full-time
- RN License
- HIPAA
- Mid-level
Quick Apply
Clinical Nurse Reviewer
Zelis —Saint Petersburg, FL
- $59,000 - $75,050 a year
- Full-time
- Nursing
- RN License
- Inventory management
- Paid holidays
- Disability insurance

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clinical reviewer jobs near florida

Psychologist Reviewer

BHM Healthcare Solutions -
Tampa, FL

Quick Apply

Job Details

Full-time
$38 - $48 an hour
8 days ago

Benefits

Health insurance
Dental insurance
401(k)
Retirement plan

Qualifications

Collaborate with healthcare professionals
Appeals
Mental health and behavioral care
Experience working with children with autism spectrum disorder (ASD)
Experience working with individuals with autism
Utilization management
Behavior analysis
Licensed Psychologist Credentials
Autism spectrum disorders support
Product release quality assurance
Documentation reviews

Full Job Description

Position Summary

The Psychologist Reviewer provides independent utilization management reviews on behalf of client health plans and insurance organizations. This role is responsible for reviewing behavioral health cases, with a primary focus on Applied Behavior Analysis (ABA) services and occasional psychological and neuropsychological testing requests. The Psychologist Reviewer performs comprehensive clinical record reviews, develops evidence-based clinical summaries, interprets and consistently applies client-specific medical necessity criteria, behavioral health policies, and evidence-based clinical guidelines, renders medical necessity determinations, participates in peer-to-peer (P2P) discussions when appropriate, and collaborates with the clinical review team throughout the review process to ensure timely, accurate, and defensible determinations.

Essential Duties and Responsibilities

Perform utilization management reviews for behavioral health prior authorization and appeal cases within required turnaround times.
Review medical records, evaluations, treatment plans, progress notes, psychological assessments, and supporting clinical documentation to determine medical necessity.
Review cases primarily involving Applied Behavior Analysis (ABA) services, with occasional psychological testing, neuropsychological testing, and other behavioral health services.
Participate in peer-to-peer discussions with treating providers daily.
Develop concise, objective, evidence-based clinical summaries supporting medical necessity determinations.
Interpret and consistently apply client-specific medical necessity criteria, InterQual criteria, behavioral health policies, and evidence-based clinical guidelines when rendering determinations.
Apply health plan policies, benefit language, and clinical criteria to determine medical necessity for requested services.
Render approval, modification, or denial determinations based on clinical documentation and applicable criteria.
Review additional clinical documentation received during reconsiderations and appeals and revise determinations when appropriate.
Collaborate with nurse reviewers, medical directors, utilization management staff, and operations personnel throughout the review process.
Ensure documentation is accurate, objective, and completed within required turnaround times.
Maintain compliance with client requirements, accreditation standards, regulatory requirements, and HIPAA.
Participate in orientation, calibration meetings, quality assurance activities, and ongoing education.

Qualifications

Doctoral degree (PhD or PsyD) in Clinical Psychology, Counseling Psychology, or School Psychology from an accredited institution.
Current, unrestricted psychologist license in at least one U.S. state is required.
Participation in PSYPACT (Psychology Interjurisdictional Compact) and/or eligibility to practice under applicable interstate compact provisions preferred.
Licensure in multiple states preferred. High-need states include but are not limited to GA, IN, WA, KY, NV, IL, OH, IA, OK
Experience with Applied Behavior Analysis (ABA) and treatment of autism spectrum disorder required.
Experience interpreting and applying medical necessity criteria, payer policies, and evidence-based clinical guidelines in a utilization management, managed care, or clinical review setting preferred.
Prior utilization management, insurance, managed care, or Independent Review Organization (IRO) experience preferred.
Excellent clinical writing, verbal, documentation, and analytical skills.
Ability to work independently while meeting required turnaround times.

Knowledge, Skills, and Abilities

Knowledge of evidence-based behavioral health treatment and psychological assessment.
Thorough knowledge of utilization management principles and the ability to interpret and apply client-specific medical necessity criteria, behavioral health policies, InterQual criteria, and payer-specific guidelines.
Ability to analyze clinical documentation and apply medical necessity criteria objectively and consistently.
Ability to synthesize complex clinical documentation into concise, objective clinical summaries and well-supported determinations.
Ability to conduct professional, collaborative, peer-to-peer discussions daily with treating providers.
Strong clinical reasoning, critical thinking, and decision-making skills.
Strong written and verbal communication skills.
Excellent organizational and time management skills.
Proficiency with electronic medical records, utilization management platforms, and Microsoft Office applications.

Primary Areas of Review

Applied Behavior Analysis services (Primary)
Psychological testing
Neuropsychological testing

Work Environment

This is a full-time (40 hours per week), Tampa, FL Office - Remote Hybrid position supporting an Independent Review Organization (IRO) that provides utilization management services for multiple health plan clients. Reviews are completed electronically using secure review platforms in accordance with client requirements, HIPAA, accreditation standards, and applicable regulatory guidelines.

Pay: $38.00 - $48.00 per hour

Benefits:

401(k)
Dental insurance
Health insurance
Retirement plan

Work Location: Hybrid remote in Tampa, FL 33609

Quick Apply

Refine Your Search

clinical reviewer jobs in florida

Psychologist Reviewer

Utilization Review Specialist (Remote)

Second Level Reviewer I PRN Remote

Utilization Review Specialist

DRG Nurse Reviewer Appeals and Hearings- Remote

Second Level Reviewer I

Medical Reviewer

Insurance Reviewer Clinical

Clinical Documentation Integrity - Second Level Reviewer

CLINICAL REVIEWER - MA - FULL TIME

Physician Reviewer - Internal Medicine

OASIS Reviewer

Utilization Reviewer 2

Utilization Management Rep I (contract)

UTILIZATION REVIEWER

Utilization Management Reviewer

RN Professional Practice Quality Reviewer (Full Time, Days)

Hospice Physician Audit Reviewer (Remote)

Intake RN

Clinical Nurse Reviewer

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