Clinical Reviewer Jobs

About The Position

Requirements

• MD or DO degree from an accredited medical school.
• Current, unrestricted Arizona medical license, or ability to obtain the required license before beginning work.
• Board certification in Pediatrics or Family Medicine.
• Strong knowledge of pediatric and adolescent development.
• Excellent clinical reasoning, analytical, and written communication skills.
• Ability to review complex medical documentation and provide clear clinical recommendations.
• Ability to meet strict deadlines and manage assigned cases independently.

Nice To Haves

• Experience working with individuals with intellectual or developmental disabilities.
• Experience with complex pediatric medical, developmental, or behavioral needs.
• Background in clinical case review, utilization review, eligibility review, or medical necessity assessment.
• Experience with interdisciplinary clinical teams.
• Familiarity with Arizona DDD programs, policies, and documentation requirements.

Responsibilities

• Review clinical assessments, medical records, and supporting documentation for assigned cases.
• Evaluate the medical, developmental, behavioral, and functional needs of children and adolescents ages 0–18.
• Consider information submitted by members and their authorized healthcare decision-makers.
• Develop clear, evidence-based clinical recommendations supported by documented rationale.
• Serve as the primary clinical reviewer and certify assigned cases in accordance with the Division’s ECR process.
• Use designated review templates and follow established documentation procedures.
• Seek discipline-specific consultation when necessary.
• Complete assigned case reviews within 48 hours of case assignment.
• Maintain accurate, objective, confidential, and timely documentation.
• Apply sound clinical judgment when reviewing complex cases and reconciling information from multiple sources.