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
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