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Care Review Processor Jobs in Washington, DC (NOW HIRING)

Sedgwick Law

Medical Bill Processor

Washington, DC · On-site

$21 - $22/hr

... bill review operations. The primary responsibility is the accurate input and maintenance of ... A diverse and comprehensive benefits package to take care of your mental, physical, financial and ...

New

Socket.dev

Scientific Reviewer

Bethesda, MD · On-site

$60 - $80/hr

Dependent Care Assistant Program (DCAP) * Transportation Reimbursement Account (TRN) Position ... Mentors and trains staff on scientific peer review processes and procedures. * Serve as the liaison ...

LifeHealth

Medical Review RN

Washington, DC · On-site

... are readiness is looking for qualified Registered Nurses (RN) responsible for the initial chart ... Performs medical Quality Assurance (QA) on all charts in various process stages. * Interfaces with ...

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All JobsCare Review Processor JobsCare Review Processor Jobs in Washington, DC

Care Review Processor information

See Washington, DC salary details

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How much do care review processor jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for care review processor in Washington, DC is $18.96, according to ZipRecruiter salary data. Most workers in this role earn between $15.24 and $21.78 per hour, depending on experience, location, and employer.

What is a care review processor?

A Care Review Processor is responsible for reviewing medical claims, authorizations, and healthcare documentation to ensure accuracy, completeness, and compliance with company policies and regulations. They work with healthcare providers, insurance companies, and internal teams to process claims efficiently. Their role helps streamline patient care by validating medical necessity and ensuring proper claim adjudication. Strong attention to detail and knowledge of medical terminology are essential for success in this position.

What are the typical daily responsibilities of a care review processor?

As a Care Review Processor, your day-to-day responsibilities usually include reviewing medical records and authorization requests, verifying insurance coverage, ensuring documentation is complete, and coordinating with healthcare providers to clarify information. You may also be responsible for entering data into claims systems, communicating with patients or case managers, and helping to resolve discrepancies or incomplete submissions. Most of your work will involve close attention to detail and following established healthcare or insurance processes. Teamwork is often part of the role, as you may collaborate with clinicians, billing teams, and customer service representatives to facilitate accurate and timely care reviews.

What are the key skills and qualifications needed to thrive in the care review processor position, and why are they important?

A Care Review Processor requires a solid understanding of healthcare procedures, medical terminology, and insurance guidelines, typically supported by experience in medical claims or healthcare administration. Familiarity with claims management software, electronic health records (EHR) systems, and Microsoft Office is often necessary, along with knowledge of HIPAA compliance requirements. Strong attention to detail, organizational skills, and the ability to communicate effectively with medical professionals and insurance providers are vital soft skills. These competencies ensure accurate review and processing of care requests while supporting efficient, compliant healthcare operations.

What are popular job titles related to Care Review Processor jobs in Washington, DC?

For Care Review Processor jobs in Washington, DC, the most frequently searched job titles are:

What job categories do people searching Care Review Processor jobs in Washington, DC look for?

The top searched job categories for Care Review Processor jobs in Washington, DC are:

Care Review Processor jobs near you
Infographic showing various Care Review Processor job openings in Washington, DC as of August 2026, with employment types broken down into 2% As Needed, 70% Full Time, 20% Part Time, and 8% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $39,440 per year, or $19 per hour.

Remote Cardiology, Physician Clinical Reviewer

Evolent

Arlington, VA • On-site, Remote

Other

Re-posted 3 days ago

Evolent rating

8.4

Company rating: 8.4 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

73rd of 500 rated business services

Job description

As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.



Collaboration Opportunities:  


  • Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers.



What You Will Be Doing:


  • Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.

  • Provides clinical rationale for standard and expedited appeals.

  • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.

  • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.

  • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.

  • Participates in on-going training per inter-rater reliability process.

  • May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.

  • On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.



Qualifications - Required and Preferred:


  • MD/DO/MBBS Degree

  • Current, unrestricted clinical license in medicine or required specialty

  • Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs

  • Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease

  • Strong clinical, management, communication, and organizational skills

  • Energetic and curious with a passion for quality and value in health care

  • Computer Proficiency

  • Minimum of five (5) years’ experience in the practice of Cardiology is preferred

  • Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.

  • No history of a major disciplinary or legal action by a state medical board

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