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Clinical Review Processor Jobs (NOW HIRING)

Nexus Health Systems

Clinical Reviewer

Houston, TX · On-site

Participate in initiatives to improve clinical review, evaluation, and admission processes ... Provide clinical guidance and support to members of the admissions and evaluation teams.

WNS Global Services

Nurse - Clinical Review

Houston, TX · On-site +1

$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 ...

Reliant Medical Group

IBR Clinical Review RN | , |

$29 - $52/hr

Employees in this position possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable processes ...

Genoa Telepsychiatry

IBR Clinical Review RN | , |

$29 - $52/hr

Employees in this position possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable processes ...

Virtix Health LLC

Clinical Quality Reviewer

Validate and support Peer-to-Peer (P2P) review processes , including confirmation of P2P ... Support a 24/7 clinical review operation , including participation in non-traditional scheduling as ...

Virtix Health LLC

Clinical Quality Reviewer

Validate and support Peer-to-Peer (P2P) review processes , including confirmation of P2P ... Support a 24/7 clinical review operation , including participation in non-traditional scheduling as ...

divvyDOSE

IBR Clinical Review RN

$29 - $52/hr

Employees in this position possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable processes ...

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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

Springdale, AR • On-site

Highlands Oncology Group
Outpatient Health Care • 501 - 1,000 employees
Learn more about Highlands Oncology Groupexternal

Other

Posted 9 days ago

Job description

Description
Be the voice that helps patients navigate their cancer care journey.
As a Clinical Review Nurse, you will serve as a critical link between providers, patients, and insurance carriers, ensuring treatment plans are reviewed efficiently and accurately. Your clinical expertise, attention to detail, and commitment to excellence will help remove barriers to care and support the best possible outcomes for our patients.
Highlands Oncology began in 1996 with three physicians and a desire to change the face of oncology care in our community. Dr. Malcolm Hayward, Dr. Dan Bradford, and Dr. Thad Beck knew that patients do better at home, in the community where they live and work, and where their support system is already in place. In furthering that goal, Highlands has grown with the region from a single location 26 years ago, to 6 locations in Northwest and Northcentral Arkansas today employing more than 800 diverse team members.
As Northwest Arkansas continues to grow, so must the services and providers available in the region. Highlands Oncology is committed to remaining on the cutting edge to ensure our community has access to the very best cancer care. What we have is something quite unique right here in our own backyard with a caring multidisciplinary team focused on treating patients like family.
Job Summary: The patient access clinical review nurse is responsible for checking medical records for appropriate criteria and providing the proper documentation. If needed, the nurse will collaborate with providers to ensure that all information needed is on record and ready for patient appointments. Clinical Review Nurses will enter orders for required testing prior to appointment per provider orders and based on patient diagnosis.
Job Duties / Responsibilities:
  • Review and analyze patient medical records, ensuring accuracy, completeness, and compliance with relevant regulations and guidelines.
  • Collaborate with healthcare professionals to determine any testing or imaging requirements prior to first patient appointment.
  • Must possess strong clinical skills and the ability to collaborate with the physicians.
  • Be willing to learn, or already have, extensive knowledge of specialty.
  • Will collaborate with the physician and other healthcare members.
  • Enter physician orders in the EMR based on diagnosis.
  • Will work closely with other members of the healthcare team in an appropriate and professional manner.
  • This position requires the employee to possess a combination of nursing skills, mental alertness, and knowledge, as well as the ability to get along with others.
Requirements
THIS POSITION REQUIRES A NURSE - LPN or RN - LICENSE MUST BE ACTIVE AND VALID IN THE STATE OF ARKANSAS.
Required Skills/Abilities:
  • Proficiency in medical terminology, healthcare regulations (e.g., HIPAA), and quality assurance processes.
  • Strong attention to detail to review and assess medical records accurately and identify any discrepancies or issues.
  • Effective written and verbal communication skills to provide feedback to healthcare providers and collaborate with multidisciplinary teams.
  • Maintain continuing education hours to maintain nursing licensure.
  • Demonstrates ongoing professional growth through and participation in relevant education.
  • Adheres to clinic standards, policies, and procedures, as well as being cost effective.
  • Able to work independently, as well as a team member.
  • Maintains a high standard of professional performance, behavior, and appearance.
  • Must be proficient in basic computer skills and utilization of MS Office Suite
  • Attend required meetings and participate in a constructive manner.
  • Participate in professional development activities and maintain professional affiliation.
  • Maintain patient confidentiality according to HIPAA rules and regulations.
  • Establish and maintain effective working relationships with physicians, patients, medical staff, and the public.
  • Ability to react calmly and effectively in emergency situations.
  • Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedures manuals and technical journals.
  • Ability to effectively present information and respond to questions from patients, caregivers, physicians, and staff.
Certifications/Licenses/Education/or Experience in a related field:
  • Nursing degree from accredited College of Nursing, accompanied by sitting for and passing the NCLEX exam maintaining in the state of Arkansas. Responsible for maintaining the required elements for successful renewal.
  • Require two (2) years of experience as a nurse, preferably in surgery or oncology.
  • Prefer oncology certification.
  • BLS certification.
  • Proficient in use of EMR (electronic medical record).
Physical Requirements:
  • The physical demands described here are representative of those that must be met by a nurse at Highlands Oncology.
  • The role of a nurse requires using the telephone, computer and other related instruments or devices while communicating with patients, caregivers, physicians, and staff.
  • While performing the duties of a nurse at Highlands Oncology, specific vision and hearing abilities required by this job include both vision and hearing acuity.
  • Employee will sit for several hours each day but will also need mobility and ability to stand and walk for periods of time.
  • May require working under stressful conditions due to deadlines and time constraints.
  • Standing and Walking: Must be able to stand and walk for extended periods throughout the shift.
  • Lifting and moving patients: Ability to lift, move, and assist patients, often requiring more than 50 pounds.
  • Pushing and Pulling: Must be able to push and maneuver equipment and patient transport devices.
  • Fine Motor Skills: Requires good hand-eye coordination to operate controls and handle small objects.
  • Repetitive Motions: Frequent use of hand and fingers for operating machinery and adjusting settings.
  • Bending and Reaching: Must bend, stoop, twist, and reach to position patients and operate equipment.
Work Environment:
  • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodation may be provided to enable individuals with disabilities to perform essential functions.
  • Due to the nature of our business and the use of radiation and hazardous chemicals, it is imperative that all employees foster a culture and environment of safety.
  • Safety Sensitive: In accordance with the Arkansas code this position is designated as a safety sensitive position wherein the employee performing the job duties under the influence may constitute a threat to health or safety.

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