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Clinical Adjudication Jobs (NOW HIRING)

State of Missouri

Clinical Pharmacist

Jefferson City, MO · On-site

$149K/yr

The ideal candidate must have a comprehensive understanding of clinical pharmacy programs, pharmacy claims processing systems, and clinical adjudication tools. A strong working knowledge of pharmacy ...

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 ...

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 ...

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

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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All JobsFinance and Insurance JobsInsurance JobsInsurance Claims Specialist JobsClinical Adjudication Jobs

Clinical Adjudication information

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$12

$41

$69

How much do clinical adjudication jobs pay per hour?

As of Aug 28, 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, 74% Full Time, 15% Part Time, and 8% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $85,542 per year, or $41.1 per hour.

Clinical Adjudication Manager (Part C)

TMF Health Quality Institute

Austin, TX • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 24 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:
Manages project activities and participates in the development and monitoring of all related tasks. Manages medical and non-medical appeals decisions.
Essential Responsibilities:
  • Plans and manages project activities to meet contract deliverables.
  • Plans, manages, and develops a standardized approach for dissemination and communication of project information.
  • Plans, manages, and develops presentations or instructional materials related to area of responsibility.
  • Plans, prepares, and facilitates regular team meetings.
  • Manages, trains, and evaluates project work activities and personnel.
  • Manages the administrative processing of appeals/disputes and the coordination of workflow among internal staff and subcontractors.
  • Manages, establishes, and maintains professional and effective working relationships with external business partners and internal staff.

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 clinical or medical administration experience 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.
  • Three (3) years management or supervisory
  • Healthcare Professional with one (1) year 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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