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Clinical Adjudication Jobs (NOW HIRING)

Capital Rx

Formulary Operations Pharmacist

Denver, CO · On-site

$60 - $72/hr

Supports thedevelopment, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists * Leadsand supports ...

Judi Health

Formulary Operations Pharmacist

Denver, CO · On-site

$60 - $72/hr

Supports the development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists * Leads and supports the ...

Capital Rx

Formulary Operations Pharmacist

Charlotte, NC · On-site

$57 - $68.25/hr

Supports thedevelopment, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists * Leadsand supports ...

Icon plc

Adjudication Project Manager

Blue Bell, PA · Remote

Adjudication Project Manager - United States (Remote) ICON is a global healthcare intelligence and clinical research organisation united by a mission to bring new medicines and treatments to patients ...

Judi Health

Formulary Operations Pharmacist

Manhattan, NY · On-site

$64.25 - $77.25/hr

Supports the development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists * Leads and supports the ...

Capital Rx

Formulary Operations Pharmacist

Manhattan, NY · On-site

$64.25 - $77.25/hr

Supports thedevelopment, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists * Leadsand supports ...

Judi Health

Formulary Operations Pharmacist

Charlotte, NC · On-site

$57 - $68.25/hr

Supports the development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists * Leads and supports the ...

New

ICON

Adjudication Project Manager

Blue Bell, PA · On-site

Adjudication Project Manager - United States (Remote) ICON is a global healthcare intelligence and clinical research organisation united by a mission to bring new medicines and treatments to patients ...

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Clinical Adjudication information

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$12

$41

$69

How much do clinical adjudication jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for clinical adjudication in the United States is $41.13, according to ZipRecruiter salary data. Most workers in this role earn between $28.85 and $52.64 per hour, depending on experience, location, and employer.

What is the difference between Clinical Adjudication vs Medical Claims Reviewer?

AspectClinical AdjudicationMedical Claims Reviewer
CredentialsCertifications in healthcare, clinical knowledgeInsurance, claims processing certifications
Work EnvironmentHospitals, healthcare facilities, insurance companiesInsurance companies, third-party administrators
Industry UsageHealthcare, insuranceInsurance, healthcare
Job FocusAssessing clinical validity of claims, medical necessityReviewing claim documentation for accuracy and compliance

While both roles involve reviewing medical information, Clinical Adjudication focuses on determining the medical necessity and validity of claims based on clinical criteria, often requiring healthcare knowledge. Medical Claims Reviewers primarily verify documentation accuracy and compliance with insurance policies. Understanding these distinctions helps clarify career paths and employer expectations in healthcare and insurance industries.

More about Clinical Adjudication jobs
What cities are hiring for Clinical Adjudication jobs? Cities with the most Clinical Adjudication job openings:
What states have the most Clinical Adjudication jobs? States with the most job openings for Clinical Adjudication jobs include:
What job categories do people searching Clinical Adjudication jobs look for? The top searched job categories for Clinical Adjudication jobs are:
Clinical Adjudication jobs near you
Infographic showing various Clinical Adjudication job openings in the United States as of August 2026, with employment types broken down into 3% As Needed, 71% Full Time, 18% Part Time, and 8% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $85,542 per year, or $41.1 per hour.

Supervisor (Clinical Adjudication) (Part C)

TMF Health Quality Institute

Austin, TX • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 3 days ago

Job description

**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote United States*
*This position requires working weekends, and rotating holidays as needed*
Position Purpose:
Provides dissatisfied patient/beneficiaries and/or providers the opportunity to present documentation to demonstrate why an appeal/dispute should be allowed. Provides an independent second level determination/dispute resolution based on the documentation, facts, laws, regulations, and guidelines.
Essential Responsibilities:
  • Oversees and participates in formal pre-decisional appellant/requestor/provider discussions for the purpose of allowing the appellant/requestor/provider to be heard and submit additional documentation; or, engages the parties in other types of communication in order to obtain information and a more complete understanding of the appeal/dispute issues.
  • Oversees and reviews medical records/case file, writes a reconsideration that is clear, concise, and impartial and supports the determination made, and documents review.
  • Oversees and makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, and policy.
  • Oversees, responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.

Minimum Qualifications
Education
  • Associate's degree or 60 or more credit hours towards a Bachelor's degree from an accredited college or university in healthcare or related discipline
    • Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate's degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Experience
  • Five (5) years conducting or overseeing Medicare appeals, medical review, or utilization management of Medicare claims.
  • Supervisory or Team Lead
  • Healthcare Professional with demonstrated experience writing, making, or overseeing Medicare related medical necessity decisions
  • Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
  • Conducting or overseeing Medicare Part C related appeals activities, preferred

Benefits
C2C offers an excellent benefits package, including:
  • Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
  • Section 125 plan
  • 401K
  • Competitive salary
  • License/credentials reimbursement
  • Tuition Reimbursement

EOE Vet/Disability
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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