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Clinical Review Analyst Jobs (NOW HIRING)

ISHE

IBR Clinical Review RN

Plymouth, MN · On-site

$60 - $108/hr

The Clinical Review Clinician serves as a subject matter expert for itemized bill reviews and ... Complete analysis of billing and departmental guidelines * Participate as needed in the achievement ...

Machinify

Manager, Complex Clinical Review

Oversee the Complex Clinical Bill Review team, managing production expectations, SLA's, client ... Analyze and track internal business requirements and processes through document and workflow ...

UnitedHealth Group

IBR Clinical Review RN

Plymouth, MN · Remote

The Clinical Review Clinician serves as a subject matter expert for itemized bill reviews and ... Complete analysis of billing and departmental guidelines * Participate as needed in the achievement ...

Centene

Clinical Review Clinician - Appeals

$27.02 - $48.55/hr

Performs clinical reviews needed to resolve and process appeals by reviewing medical records and ... analyzing the basis for the appeal * Ensures timely review, processing, and response to appeal in ...

Texas Health Institute

$83.10/hr

The Clinical Review Clinician serves as a subject matter expert for itemized bill reviews and ... Complete analysis of billing and departmental guidelines * Participate as needed in the achievement ...

University of Minnesota School of Nursing

$60 - $108/hr

The Clinical Review Clinician serves as a subject matter expert for itemized bill reviews and ... Complete analysis of billing and departmental guidelines * Participate as needed in the achievement ...

ISHE

$60 - $108/hr

The Clinical Review Clinician serves as a subject matter expert for itemized bill reviews and ... Complete analysis of billing and departmental guidelines * Participate as needed in the achievement ...

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How much do clinical review analyst jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for clinical review analyst in the United States is $39.80, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $45.67 per hour, depending on experience, location, and employer.

What is a clinical review analyst?

Clinical Review Analysts are healthcare professionals who evaluate medical records, treatment plans, and claims to ensure they meet established guidelines and standards. They work for insurance companies, hospitals, or healthcare organizations, reviewing clinical documentation to determine the necessity and appropriateness of medical services. Their role is crucial in ensuring that patients receive proper care while also managing healthcare costs and compliance. Clinical Review Analysts often collaborate with medical providers and may provide recommendations for care improvement or denial of claims when necessary.

What are the key skills and qualifications needed to thrive as a clinical review analyst?

To thrive as a Clinical Review Analyst, you need a strong background in healthcare, medical terminology, and case review, often supported by a clinical degree or relevant certification such as RN, LPN, or coding credentials. Familiarity with utilization management software, electronic health records (EHR), and medical coding systems like ICD-10 and CPT is usually required. Attention to detail, analytical thinking, and effective communication are critical soft skills for accurately assessing medical records and collaborating with providers. These skills ensure quality, compliance, and effective decision-making in the review and authorization of clinical services.

What are some common challenges faced by clinical review analysts, and how can they be effectively managed?

Clinical Review Analysts often encounter challenges such as interpreting complex medical records, keeping up with evolving healthcare regulations, and balancing caseloads with tight deadlines. Effective management of these challenges involves staying current with industry guidelines, leveraging electronic health record (EHR) systems for efficient data retrieval, and collaborating closely with medical professionals to clarify clinical details. Strong organizational skills and ongoing professional development can also help analysts maintain accuracy and compliance in their reviews.

How to become a clinical review analyst?

To become a clinical review analyst, candidates typically need a bachelor's degree in healthcare, nursing, or a related field, along with experience in clinical settings or healthcare data analysis. Strong analytical skills, knowledge of medical coding and documentation, and familiarity with electronic health records (EHR) systems are important. Some roles may require certification such as Certified Professional Coder (CPC) or similar credentials.
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Clinical Review Analyst jobs near you
Infographic showing various Clinical Review Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $82,791 per year, or $39.8 per hour.

Clinical Review Specialist (Ukiah)

Nwregionalheart

Ukiah, CA • On-site

$70 - $90/hr

Other

Posted 19 days ago

Job description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters are based in Roseville, California.

Job Summary

Responsible for the collection, abstraction, validation, and submission of clinical data to support CMS quality programs, patient safety measures, national clinical registries and/or peer review data. Ensures the accuracy and integrity of reported data, supports compliance with regulatory requirements, and contributes to performance improvement initiatives. Applies clinical knowledge to identify trends, monitor quality outcomes, and provide actionable feedback to leaders and clinicians. Supports confidentiality of peer review activities, prepares trended reports for leadership and medical staff committees, and assists in maintaining compliance with accreditation and regulatory standards. Is essential to achieving internal and external quality and patient safety targets.

Job Requirements

Education and Work Experience:

  • Associate's or Technical Degree in Nursing, Healthcare Administration, or Health Information Management or equivalent combination of education and experience: Required
  • Two years' of experience in quality management, data abstraction, or healthcare analytics: Required
  • Three years' of experience in peer review, abstraction, quality assurance, or hospital data reporting: Preferred

Licenses/Certifications:

  • Registered Nurse (RN) license or equivalent health background: Preferred
  • Certified Professional in Healthcare Quality (CPHQ) or CPPS: Required
Essential Functions
  • Performs concurrent and retrospective chart abstraction for peer review, quality, and regulatory reporting using defined criteria. Ensures data accuracy and timeliness of submissions to internal and external databases.
  • Performs case abstraction for assigned registries and/ or CMS IOR and QOR measures (e.g., STS, CoC, NSQIP, or other specialty registries). Collaborates with outsourced registry vendors and maintain effective communication with system quality teams. Ensures timely data submission to meet internal and external reporting requirements.
  • Serves as a liaison between the Quality Department, clinical stakeholders, and registry partners. Provides feedback to physicians, nurses, and leaders on documentation gaps or trends impacting data accuracy. Supports initiatives to improve compliance with quality metrics.
  • Adheres to all confidentiality requirements under state and federal peer review protections. Ensures that data collection and storage comply with Evidence Code §1157, PSWP, and organizational policies.
  • Monitors data trends to identify opportunities for clinical process improvement. Provides reports and data insights to Quality and Patient Safety leaders. Supports performance improvement teams with accurate, validated data to guide interventions.
  • Performs other job-related duties as assigned.
Organizational Requirements

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

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