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Clinical Review Processor Jobs (NOW HIRING)

Turning Point Plans

Clinical Review Nurse

Lake Mary, FL · On-site

As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise ... Improve quality results by studying, evaluating procedures and processes and recommending changes ...

Comagine

$80K - $102K/yr

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Supervisor, Clinical Review Alabama ...

Actalent

Clinical Review Clinician - Appeals

Charlotte, NC · On-site

$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

Miami, FL · On-site

$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

Phoenix, AZ · On-site

$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 ...

TPIS

Clinical Review Nurse

San Juan, PR · On-site

$21/hr

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Clinical Review Nurse San Juan, PR, PR ...

WNS Global Services

Nurse - Clinical Review

Houston, TX · Remote

$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 ...

HealthHelp

Nurse Clinical Review

Houston, TX · On-site

$65K - $75K/yr

... clinical review process and ensure appropriate care decisions. • Effectively utilizes various ... computer systems and software to manage cases and document reviews. • Promotes business focus ...

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Clinical Review Processor information

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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

Clinical Review Nurse

Lake Mary, FL • On-site

TurningPoint Healthcare Solutions, LLC
Health Care and Social Assistance • 51 - 200 employees
Learn more about TurningPoint Healthcare Solutions, LLCexternal

Full-time

Re-posted 4 days ago

Job description

TurningPoint Healthcare Solutions is a rapidly growing and innovative healthcare company that supports several large national health plans to improve the quality and affordability of healthcare patients receive. We are looking for motivated individuals who want to be part of our mission and join our team!

As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with established medical criteria to perform first level clinical review for select procedures that require medical necessity authorization. We are seeking individuals who enjoy a challenge, have an ability to work independently and are capable of meeting deadlines. Previous utilization management experience is preferred. In addition to prior experience, the ideal candidate will have an extreme attention to detail, an ability to flourish in a fast-paced environment and advanced grammar, punctuation, and computer skills.

Responsibilities

  • Perform initial clinical reviews and provide documented recommendations based on the use of appropriate clinical guidelines
  • Review the initial evaluation and clinical documentation against clinical standards, applicable state regulations and relevant treatment guidelines
  • Assist clinical staff in quality improvement projects to provide instructive feedback to clients and providers within scope of practice
  • Resolve patient care issues by working one-on-one with community providers and staff to resolve issues in the determination process
  • Provide information by responding to queries of physicians and their practice staff, sorting and distributing messages and documents, and preparing information for determinations
  • Improve quality results by studying, evaluating procedures and processes and recommending changes, if needed
  • Serves and protects the company by adhering to accreditation standards, professional standards, company policies and procedures, federal, state, and local requirements, and professional and licensing standards

Qualifications:

  • Licensed Nurse Practitioner (LPN) or Registered Nurse (RN) required
  • Comprehensive knowledge of general nursing theory and practices
  • Excellent customer service skills and phone etiquette
  • Proficient computer skills, including typing and an ability to maneuver through various programs
  • Previous Utilization Management experience preferred but not required
  • Knowledge of musculoskeletal surgical procedures, cardiac procedures, pain management and/ or wound care is a plus
  • Ability to multi-task and manage tasks to completion on a timely basis and in an organized fashion
  • Ability to work collaboratively as part of a team
Salary:
RN- 62k-68k
LPN- 52k-58k

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