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Clinical Adjudication Jobs (NOW HIRING)

Cynet Systems

Clinical Medical Review Nurse

Baltimore, MD · On-site

$36.49 - $41.49/hr

Pay Range: $36.49hr - $41.49hr Responsibilities Review, research, and analyze professional and institutional claims using clinical judgment and medical policies for accurate adjudication. Conduct ...

Cherokee Nation

Clinical Assistant

Jay, OK · On-site

Overview GENERAL DESCRIPTION Provides clinical and administrative support to healthcare providers ... adjudication for childcare. • Adheres to all organizational policies, including confidentiality ...

Cherokee Nation

Clinical Assistant

Muskogee, OK · On-site

Overview GENERAL DESCRIPTION Provides clinical and administrative support to healthcare providers ... adjudication for childcare. • Adheres to all organizational policies, including confidentiality ...

Rx Savings Solutions

Clinical Pharmacist - Sales

Leawood, KS · On-site

$115K - $137K/yr

Clinical Pharmacist - Sales McKesson is an impact-driven, Fortune 10 company that touches virtually ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...

New

MCKESSON

Clinical Pharmacist - Sales

Alpharetta, GA

$115K - $137K/yr

The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...

McKesson

Clinical Pharmacist - Sales

Irving, TX

$113K - $135K/yr

The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...

McKesson

Clinical Pharmacist - Sales

Columbus, OH · On-site

$114K - $136K/yr

The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...

Rx Savings Solutions

Clinical Pharmacist - Sales

Columbus, OH · On-site

$110K - $132K/yr

Clinical Pharmacist - Sales McKesson is an impact-driven, Fortune 10 company that touches virtually ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...

Rx Savings Solutions

Clinical Pharmacist - Sales

Atlanta, GA · On-site

$114K - $136K/yr

Clinical Pharmacist - Sales McKesson is an impact-driven, Fortune 10 company that touches virtually ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...

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Showing results 21-40

All JobsClinical Adjudication Jobs

Clinical Adjudication information

See salary details

$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.

Clinical Adjudication Manager (Weekday Evening Shift + Flexible Scheduling (Part Time or Full Time)

TMF Health Quality Institute

Austin, TX • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 28 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 is weekday evening shift (Part Time or Full Time) and has flexible scheduling
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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