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Clinical Reviewer Jobs (NOW HIRING)

Astyra Corporation

Clinical Reviewer

Indianapolis, IN · Remote

$36 - $40/hr

Job Summary The purpose of this position is to utilize clinical expertise to review medical records against established criteria in accordance with contract requirements. Location: Remote (U.S.-based ...

mycenters

UM Clinical Reviewer

Pompano Beach, FL

The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their ...

TriWest Healthcare

ABA Clinical Reviewer

Phoenix, AZ · On-site

Prepares and presents more complex cases for Medical Director review. Advises non-clinical staff on clinical coding questions. This position reports to the Director, Case Management Programs.

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 Type: Full-time, Temp-to-hire (5 days a week) * Hourly Rate: $60/hr About Greenlife Healthcare ...

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How much do clinical reviewer jobs pay per hour?

As of Jun 7, 2026, the average hourly pay for clinical 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 are some common challenges Clinical Reviewers face when evaluating medical records, and how can they be addressed?

Clinical Reviewers often encounter challenges such as incomplete documentation, inconsistent terminology, and tight deadlines when evaluating medical records. To overcome these issues, it's important to develop strong attention to detail, stay current with medical coding standards, and communicate effectively with healthcare providers to clarify ambiguities. Collaborating closely with clinical teams and leveraging electronic health record (EHR) systems can also help streamline the review process and ensure accuracy.

What Does a Clinical Reviewer Do?

A clinical reviewer monitors healthcare documents to ensure compliance before submitting to insurance companies. You handle the daily responsibilities of checking medical records for appropriate criteria and providing the proper documentation. You collaborate with providers to ensure all information is accurate. Your duties are also to review requests for services, research and gather further information when necessary, perform an information audit, and evaluate procedures for approval. You also record, analyze, and report data elements that could help improve the quality of care of a patient.

What are the key skills and qualifications needed to thrive as a Clinical Reviewer, and why are they important?

To thrive as a Clinical Reviewer, you need a strong background in healthcare or life sciences, often supported by a relevant degree and experience in clinical settings. Familiarity with medical terminology, regulatory requirements, and systems such as electronic medical records (EMRs) or clinical trial management software is typical. Attention to detail, analytical thinking, and effective written communication are standout soft skills for this role. These skills ensure accurate evaluation of clinical data, compliance with standards, and clear reporting, which are critical for patient safety and regulatory approval.

What is the difference between Clinical Reviewer vs Medical Reviewer?

AspectClinical ReviewerMedical Reviewer
Required CredentialsRN, LPN, or other healthcare licenses; sometimes certifications in case management or clinical reviewMD or DO; medical license; often board-certified in a specialty
Work EnvironmentInsurance companies, healthcare organizations, or government agencies; reviewing medical records and claimsHospitals, clinics, insurance companies; evaluating medical records and providing expert opinions
Employer & Industry UsagePrimarily in insurance and healthcare administrationPrimarily in insurance, healthcare, and legal settings

Both Clinical Reviewers and Medical Reviewers assess medical information, but Clinical Reviewers typically hold nursing or allied health credentials and focus on case management and claims review. Medical Reviewers are licensed physicians who provide expert medical opinions. The roles often overlap in insurance and healthcare industries, but their credentials and scope of practice differ.

What are clinical reviewers?

Clinical reviewers are professionals who evaluate medical records, clinical data, or healthcare documentation to ensure accuracy, compliance, and quality of care. They may work in settings such as hospitals, insurance companies, or regulatory agencies to review cases for appropriateness of care, adherence to clinical guidelines, or for billing and coding accuracy. Clinical reviewers often have backgrounds in nursing, medicine, or another healthcare field and use their expertise to make informed assessments. Their work is critical for improving patient outcomes, supporting proper reimbursement, and maintaining regulatory standards.
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Clinical Reviewer jobs near you

Clinical Reviewer

Skilled Healthcare Facility

Lincoln, IL

Full-time

Posted 12 days ago

Job description

Job Summary:
The Clinical Reviewer ensures quality care by evaluating medical records, treatment plans, and procedures for compliance with industry standards and regulations. This role requires expertise in medical terminology, healthcare protocols, and attention to detail to uphold high standards of patient care and safety.

Key Responsibilities:

  • Review and assess medical records for accuracy and regulatory compliance.
  • Evaluate the quality of care and identify areas for improvement.
  • Ensure proper documentation of diagnoses, treatment plans, and progress notes.
  • Stay current on healthcare regulations and ensure alignment with best practices.
  • Collaborate with healthcare professionals to enhance care and documentation.

Qualifications:

  • Bachelor’s degree in Nursing, Healthcare Administration, or related field (clinical background/certification preferred).
  • 2+ years of clinical or healthcare administration experience.
  • Knowledge of medical terminology, healthcare regulations (e.g., HIPAA), and quality assurance.
  • Strong attention to detail and communication skills.