ZipRecruiter

Log In

1

Clinical Review Processor Jobs (NOW HIRING)

Molina Healthcare

Care Review Processor

Long Beach, CA · On-site

$20.34 - $30.39/hr

Job SummaryProvides non-clinical administrative support to utilization management team and ... Essential Job Duties Provides telephone, clerical and data entry support for the care review team.

NTT DATA Services

BPO Clinical Review Specialist

Tampa, FL · On-site

$76K/yr

Clinical Reviewer Specialist (RN) Position Summary The Clinical Reviewer Specialist is responsible ... Knowledge of utilization management and medical necessity review processes. * Understanding of NCQA ...

NTT DATA Services

BPO Clinical Review Specialist

FL · On-site

$62K/yr

Clinical Reviewer Specialist (LPN) Position Summary The Clinical Reviewer Specialist is responsible ... Knowledge of utilization management and medical necessity review processes. * Understanding of NCQA ...

NTT DATA Services

BPO Clinical Review Specialist

FL · On-site

$76K/yr

Clinical Reviewer Specialist (RN) Position Summary The Clinical Reviewer Specialist is responsible ... Knowledge of utilization management and medical necessity review processes. * Understanding of NCQA ...

HealthHelp

Nurse - Clinical Review

$65K - $75K/yr

Engages in phone conversations with ordering providers, members, internal staff, primary care physicians (PCPs), and rendering providers as necessary to facilitate the clinical review process and ...

Actalent

Clinical Review Clinician - Appeals

$30 - $40/hr

RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for Appeals is ... Ensure timely review, processing, and response to appeals in accordance with State, Federal, and ...

Actalent

Clinical Review Clinician - Appeals

$30 - $40/hr

RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for Appeals is ... Ensure timely review, processing, and response to appeals in accordance with State, Federal, and ...

Actalent

Clinical Review Clinician - Appeals

$30 - $40/hr

RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for Appeals is ... Ensure timely review, processing, and response to appeals in accordance with State, Federal, and ...

next page

Showing results 1-20

All JobsHealthcare JobsHospital JobsMedical Reviewer JobsClinical Review Processor Jobs

Clinical Review Processor information

See salary details

$5

$15

$16

How much do clinical review processor jobs pay per hour?

As of Sep 13, 2026, the average hourly pay for clinical review processor in the United States is $15.87, according to ZipRecruiter salary data. Most workers in this role earn between $15.87 and $15.87 per hour, depending on experience, location, and employer.

What is a clinical review processor?

A Clinical Review Processor is a healthcare professional responsible for reviewing medical records, insurance claims, and related documentation to ensure accuracy, compliance, and proper authorization. They evaluate whether healthcare services meet clinical guidelines and payer requirements, often working for insurance companies, hospitals, or third-party administrators. Their work helps determine the necessity of medical treatments and whether claims should be approved or denied. Clinical Review Processors play a key role in maintaining the integrity and efficiency of the healthcare reimbursement process.

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

To thrive as a Clinical Review Processor, you need a background in healthcare or medical administration, strong analytical skills, and attention to detail, often complemented by a related degree or certification. Familiarity with medical coding systems (like ICD-10, CPT), healthcare management software, and electronic health records (EHRs) is typically required. Excellent communication, organizational abilities, and critical thinking are valuable soft skills for collaborating with clinicians and ensuring accurate reviews. These skills and qualifications are crucial for efficiently evaluating medical records, supporting compliance, and ensuring quality patient care decisions.

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

Clinical Review Processors often encounter challenges such as managing high volumes of medical records, meeting tight deadlines, and interpreting complex clinical documentation. Staying organized and maintaining strong attention to detail are key to success in this role. Collaborating closely with clinical teams and utilizing electronic health record (EHR) systems can help streamline workflows and reduce errors. Continuous professional development and seeking feedback from experienced colleagues also support personal growth and efficiency.

What are popular job titles related to Clinical Review Processor jobs?

For Clinical Review Processor jobs, the most frequently searched job titles are:

Clinical Review Processor jobs near you

Care Review Processor

Long Beach, CA • On-site

Molina Healthcare
Health Care and Social Assistance • 10K+ employees
Learn more about Molina Healthcareexternal

$20.34 - $30.39/hr

Full-time

Re-posted 7 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

Job description

JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
Provides telephone, clerical and data entry support for the care review team. 
Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges and billing codes. 
Responds to requests for authorization of services submitted via phone, fax and mail according to operational timeframes. 
Contacts physician offices according to department guidelines to request missing information from authorization requests or for additional information as requested medical directors. 
Required Qualifications

 At least 1 year of experience in an administrative support role, preferably within a health care environment supporting correspondence or clinical communications, or equivalent combination of relevant education and experience. 
Strong attention to detail, and ability to work within regulatory and internal requirements for letter generation. 
Strong organizational and time-management skills, and ability to manage multiple letter queues and deadlines. 
Excellent verbal and written communication skills, and ability to ensure clarity and precision in all correspondence. 
Willingness to learn and adapt to new programs, software systems, and lines of business. 
Ability to research, obtain feedback, and integrate necessary adjustments into letters to meet quality standards. 
Ability to manage multiple tasks simultaneously, and ensure quality and compliance in all produced correspondence. 
Ability to maintain confidentiality and ensure compliance with all relevant guidelines, regulations, and policies in processing of clinical correspondence. 
Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet deadlines. 
Ability to collaborate effectively with team members and internal departments. 
Basic Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
Previous experience in a health care correspondence or clinical communications role, with an understanding of regulatory and accreditation rules related to clinical determinations. 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $20.34 - $30.39 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Molina Healthcare logo

About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

FacebookTwitter

View All Molina Healthcare Jobs

Apply