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Greenlife Healthcare Staffing

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RN Clinical Reviewer

Albany, NY · On-site

$60/hr

RN Clinical Reviewer - Jericho or Albany, NY (#25332) * Location: Jericho orAlbany, NY * Employment ... Health Insurance subject to plan eligibility requirements * Work Schedule: Full-time position, 5 ...

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How much do clinical insurance reviewer jobs pay per hour?

As of Jun 7, 2026, the average hourly pay for clinical insurance reviewer in the United States is $35.92, according to ZipRecruiter salary data. Most workers in this role earn between $31.25 and $40.38 per hour, depending on experience, location, and employer.

What is a Clinical Insurance Reviewer job?

A Clinical Insurance Reviewer evaluates medical claims to ensure they meet insurance policies and clinical guidelines. They review patient records, verify medical necessity, and determine coverage eligibility. This role requires knowledge of medical terminology, coding, and insurance regulations. Clinical Insurance Reviewers help prevent fraud, ensure compliance, and support fair reimbursement for healthcare providers and patients.

What are the key skills and qualifications needed to thrive in the Clinical Insurance Reviewer position, and why are they important?

To thrive as a Clinical Insurance Reviewer, you need a solid understanding of clinical practices, medical terminology, and insurance guidelines, often supported by a background in nursing or other healthcare professions. Familiarity with electronic medical records (EMRs), claims management systems, and utilization review software is highly valuable, and certifications such as Certified Professional in Healthcare Quality (CPHQ) can be advantageous. Strong analytical thinking, attention to detail, and effective communication skills set top performers apart in this role. These skills are crucial for accurately evaluating medical claims, ensuring compliance, and facilitating clear communication between healthcare providers and insurance companies.

What are the typical daily responsibilities of a Clinical Insurance Reviewer?

Clinical Insurance Reviewers spend much of their day reviewing medical records and patient documentation to determine the medical necessity and appropriateness of treatments for insurance coverage. They assess claims against clinical guidelines, communicate their findings with healthcare providers or case managers, and may also participate in peer-to-peer reviews or appeals. Most positions involve working closely with other reviewers, physicians, and administrative staff, either remotely or in a collaborative office setting. This role requires strong organizational skills as well as the ability to manage multiple case reviews and deadlines simultaneously.

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Clinical Insurance Reviewer jobs near you
Infographic showing various Clinical Insurance Reviewer job openings in the United States as of May 2026, with employment types broken down into 83% Full Time, 13% Part Time, and 4% Contract. Highlights an 87% In-person, and 13% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.
Behavioral Health Clinical Reviewer

Behavioral Health Clinical Reviewer

Nexus Health Systems Ltd

Houston, TX • On-site

Full-time

Posted 23 days ago

Nexus Health Systems rating

6.3

Company rating: 6.3 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Position Summary

The Behavioral Health Clinical Reviewer is responsible for evaluating clinical records and referral documentation to determine eligibility and fit for Nexus behavioral health and neurodevelopmental programs. This role involves preparing high-quality clinical evaluations and summaries that meet payer requirements, including insurance and Medicaid standards. The reviewer ensures admissions decisions are made efficiently, accurately, and in compliance with regulatory, clinical, and Nexus program guidelines.

Key Responsibilities

Referral & Record Review

  • Review incoming referral packets, medical and clinical histories, assessments, and related documentation.

  • Determine program appropriateness for behavioral health, autism, intellectual/developmental disabilities, and medically complex cases.

Funder & Payer Compliance

  • Maintain up-to-date knowledge of insurance and Medicaid documentation standards.

  • Draft clinical documentation that addresses payer expectations and anticipates potential questions or objections.

Collaboration & Communication

  • Partner with referral sources, families, and internal teams to clarify information and obtain missing documentation.

  • Clearly communicate admission decisions and next steps.

Timeliness & Quality

  • Process referrals and evaluations promptly while maintaining clinical accuracy and compliance.

  • Balance efficiency with quality, ethics, and thoroughness.

Continuous Learning & Improvement

  • Stay current on behavioral health conditions, neurodevelopmental disorders, and medical complexities.

  • Monitor evolving payer policies, assessment tools, and evidence-based practices.

Qualifications

Education

  • Master’s degree in Social Work, Clinical Psychology, Counseling, Applied Behavior Analysis, or a related behavioral health field; or Bachelor’s degree in Nursing.

  • Doctoral degree (PhD, PsyD, DSW) preferred but not required.

Experience

  • Minimum 3 years of clinical experience in behavioral health, developmental disabilities, or autism spectrum disorders.

  • Proven experience writing clinical assessments/evaluations for payer or insurance approval.

  • Familiarity with private insurance and Medicaid authorization processes.

  • Experience collaborating with interdisciplinary clinical teams.

Licensure/Certification

  • Active clinical license (e.g., LCSW, LPC, LMFT, BCBA, RN, Psychologist) OR eligibility to obtain licensure in Texas.

Skills & Attributes

  • Exceptional written communication skills, with ability to draft clear, concise, and persuasive clinical narratives.

  • Strong interpersonal skills with the ability to work compassionately with families, clinicians, and referral partners.

  • High attention to detail and strong critical thinking.

  • Ability to prioritize, multi-task, and meet deadlines in a fast-paced setting.

  • Proficiency with EMR and CRM systems.