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Clinical Reviewer Jobs (NOW HIRING)

Jobgether

Clinical Reviewer

$28.37 - $32/hr

Our partner is looking for a Clinical Reviewer based in the United States. This role plays a key part in ensuring the medical appropriateness and quality of clinical determinations within a ...

New

Blue Cross of Idaho

Clinical Reviewer

Meridian, ID · On-site

Clinical Reviewer Blue Cross of Idaho is seeking a Clinical Reviewer to support the Healthcare Operations initiatives to ensure the delivery of medically necessary and appropriate, cost-effective and ...

Blue Cross of Idaho

Clinical Reviewer

Meridian, TX · On-site +1

Blue Cross of Idaho is seeking a Clinical Reviewer to support the Healthcare Operations initiatives to ensure the delivery of medically necessary and appropriate, cost-effective and timely, quality ...

Comagine

Clinical Reviewer

In this role, you will review clinical documentation to determine medical necessity and appropriateness of services, complete functional needs assessments that evaluate how mental health symptoms ...

Hire Talent

Clinical Reviewer

Mclean, VA · On-site

Title: Clinical Reviewer Location: Remote Work Duration: 03 Month contract (Extension possible) The purpose of this position is to utilize clinical expertise to review medical records against ...

Comagine Health

Clinical Reviewer

Position Overview We are seeking a Clinical Utilization Review Nurse (RN) to assess the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective ...

Astyra Corporation

Clinical Reviewer

Indianapolis, IN · Remote

$38 - $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 ...

Acentra Health

Clinical Reviewer

Mclean, VA · On-site

Job Summary and Responsibilities Acentra Health is looking for a Clinical Reviewer (LPN, LVN, RN) to join our growing team. Job Summary: The purpose of this position is to review medical records ...

Comagine Health

Clinical Reviewer DC

Washington, DC · On-site

The Clinical Reviewer position supports utilization management activities by assessing the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective ...

Comagine

Clinical Reviewer DC

Washington, DC · On-site

Clinical Reviewer Position Are you passionate about using your clinical expertise to support quality healthcare outcomes and ensure members receive medically appropriate services? Do you enjoy ...

Medix

Clinical Reviewer

Phoenix, AZ · On-site

$140 - $145/hr

This project involves evaluating historically denied cases to determine if standard clinical criteria were appropriately applied. Because these are retrospective reviews, they will have no impact on ...

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 ...

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Clinical Reviewer information

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$24

$35

$46

How much do clinical reviewer jobs pay per hour?

As of Jun 30, 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.

How much does a clinical data reviewer make?

A clinical data reviewer typically earns between $50,000 and $80,000 annually, depending on experience, location, and the employer. The role often requires familiarity with electronic data capture systems and attention to detail, with some positions offering additional benefits or bonuses.

What does a clinical reviewer do?

A clinical reviewer evaluates medical records, treatment plans, and patient data to determine coverage, compliance, and medical necessity for insurance companies or healthcare organizations. They ensure that clinical guidelines are followed and may use electronic health record systems and medical coding tools as part of their work. Strong knowledge of medical terminology and healthcare regulations is essential for this role.

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.

How do you become a medical reviewer?

To become a clinical reviewer, candidates typically need a medical degree such as an MD or DO, along with clinical experience in a relevant specialty. Additional qualifications often include knowledge of healthcare regulations, strong analytical skills, and familiarity with medical records and documentation; some roles may require certification or training in medical review processes.

What jobs pay 2000 a day?

Clinical reviewers typically do not earn $2,000 a day; their salaries are usually based on annual or hourly rates. High-paying roles in healthcare or consulting, such as specialized physicians, senior consultants, or executive-level positions, can reach or exceed this daily rate, often requiring advanced certifications, extensive experience, and a high level of expertise.

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.
More about Clinical Reviewer jobs
What cities are hiring for Clinical Reviewer jobs? Cities with the most Clinical Reviewer job openings:
What are the most commonly searched types of Clinical Reviewer jobs? The most popular types of Clinical Reviewer jobs are:
Who are the top companies hiring for Clinical Reviewer jobs? The top employers for Clinical Reviewer jobs are:
What states have the most Clinical Reviewer jobs? States with the most job openings for Clinical Reviewer jobs include:
What job categories do people searching Clinical Reviewer jobs look for? The top searched job categories for Clinical Reviewer jobs are:
Clinical Reviewer jobs near you
Infographic showing various Clinical Reviewer job openings in the United States as of June 2026, with employment types broken down into 17% As Needed, 8% Full Time, and 75% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.

Clinical Reviewer

Jobgether

Remote

$28.37 - $32/hr

Other

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Clinical Reviewer based in the United States.
This role plays a key part in ensuring the medical appropriateness and quality of clinical determinations within a structured, regulated healthcare review environment. You will apply clinical judgment, critical thinking, and regulatory knowledge to evaluate cases and support accurate, timely decision-making aligned with contract and compliance requirements. The position involves direct interaction with clinical workflows, provider communication, and coordination with internal teams to ensure consistency and quality across reviews. You will contribute to maintaining high standards of accuracy while supporting production and turnaround expectations in a fast-paced setting. This is a highly detail-oriented role where clinical expertise directly supports better healthcare outcomes and operational efficiency. The environment is collaborative, mission-driven, and aligned with national healthcare quality standards. The role operates on an 11:00 AM to 8:00 PM EST schedule.
Accountabilities:
In this role, you will apply clinical knowledge and regulatory understanding to support accurate, compliant, and timely medical review processes. Your responsibilities include:
  • Conducting clinical reviews to assess medical appropriateness in accordance with contract and regulatory requirements
  • Ensuring accuracy, consistency, and timeliness of all assigned case reviews within established service standards
  • Managing daily workload, call queues, and review assignments while adjusting priorities to meet operational demands
  • Serving as a clinical resource for peers and supporting nurse reviewers with process-related questions
  • Participating in quality monitoring activities and supporting identification and implementation of process improvements
  • Acting as a liaison between providers and internal teams to resolve issues and support customer service needs
  • Maintaining compliance with NCQA standards, HIPAA regulations, and organizational policies
  • Attending training sessions and meetings to stay current on clinical guidelines and review procedures
  • Cross-training on additional contract workflows to support workforce flexibility and coverage needs
Requirements:
This role requires strong clinical expertise, regulatory awareness, and excellent communication skills to support healthcare review processes. Ideal candidates should have:
  • Active, unrestricted LPN, RN, Social Worker, or other applicable clinical license in a U.S. state or compact state
  • Strong understanding of medical terminology, disease processes, and clinical documentation
  • Experience with medical record review, abstracting, or utilization review processes
  • Strong clinical assessment, critical thinking, and decision-making skills
  • Excellent written and verbal communication abilities
  • Ability to manage workload effectively in a structured, deadline-driven environment
  • Familiarity with case management, prior authorization, or utilization review (preferred)
  • Experience in a call center or behavioral health setting (a plus)
  • Bachelor's degree in a related field (preferred but not required)
  • Bilingual English/Spanish skills (a plus)
  • Ability to work consistently within the required 11:00 AM - 8:00 PM EST schedule
Benefits:
  • Competitive hourly compensation: USD $28.37 - $32.00 per hour
  • Comprehensive health insurance plans (medical, dental, and vision)
  • Paid time off and holiday programs
  • Retirement savings plans
  • Corporate wellness and employee assistance programs
  • Educational assistance and professional development opportunities
  • Corporate discounts and employee support resources
  • Fully structured clinical review environment with clear processes and training support
  • Opportunity to contribute directly to improving healthcare outcomes nationwide
  • Stable weekday schedule (11:00 AM - 8:00 PM EST)

How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

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