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Clinical Reviewer Jobs (NOW HIRING)

MedRisk

Clinical Reviewer

Washington, DC · On-site

Clinical Reviewer And Tele-Services Clinician A Clinical Reviewer and Tele-Services Clinician is responsible for reviewing medical records, patient information, and treatment plans to ensure ...

New

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 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 ...

Comagine

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 ...

Medix

Clinical Reviewer

Phoenix, AZ · On-site

$40 - $42/hr

Job Summary Our client is hiring a Substance Use Disorder (SUD) Clinical Reviewer for a fiscal year 2025-2026 project. The reviewer will be responsible for completing a third-party overread of ...

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

Review escalated cases and render a final determination. * Assess whether ASAM criteria were appropriately applied. * Utilize The ASAM Navigator by InterQual for determinations. * Document brief case ...

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 ...

Acentra Health

Clinical Reviewer-SCA

Mclean, VA · On-site

The Clinical Reviewer utilizes clinical expertise during beneficiary interaction in conjunction with contract requirements, critical thinking and utilizes decision-making skills to assist with ...

Greenlife Healthcare Staffing

Be Seen First

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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Clinical Reviewer information

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How much do clinical reviewer jobs pay per hour?

As of Jul 21, 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 claims or healthcare programs. They often work with healthcare providers and use clinical guidelines to ensure accurate and consistent assessments, typically requiring knowledge of medical terminology and documentation standards.

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 to become a clinical nurse reviewer?

To become a clinical nurse reviewer, candidates typically need a registered nurse (RN) license, relevant clinical experience, and knowledge of healthcare policies. Many employers prefer candidates with experience in case review, medical records, or healthcare compliance, and some roles may require certification such as Certified Case Manager (CCM) or similar credentials.

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.

How to become a clinical data reviewer?

To become a clinical data reviewer, candidates typically need a bachelor's degree in a health-related field such as nursing, pharmacy, or life sciences. Relevant experience in clinical research, data management, or regulatory environments is often required, along with knowledge of clinical trial protocols and data analysis tools like EDC systems. Certifications such as Certified Clinical Data Manager (CCDM) can enhance job prospects.
More about Clinical Reviewer jobs
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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 July 2026, with employment types broken down into 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.
Clinical Reviewer

Clinical Reviewer

MedRisk

Washington, DC • On-site

Other

Posted 4 days ago

New

MedRisk rating

8.0

Company rating: 8.0 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

105th of 451 rated business services

Job description

Clinical Reviewer And Tele-Services Clinician

A Clinical Reviewer and Tele-Services Clinician is responsible for reviewing medical records, patient information, and treatment plans to ensure compliance with clinical guidelines and standards. They also provide tele-services, such as telemedicine or teletherapy, to patients remotely. This role requires strong clinical knowledge, excellent communication skills, and the ability to make informed decisions regarding patient care.

Primary Duties & Responsibilities

  • Tele-services
  • Applies MedRisk's telerehabilitation and consultation program inclusion guidelines to assigned cases to determine eligibility and appropriateness.
  • Executes PT/OT evaluation and treatment consistent with telerehabilitation clinical guidelines.
  • Executes OT/OT telephonic consultation consistent with program's guidelines.
  • Documents telerehabilitation visits and consultation in a manner consistent with company policies and department procedures.
  • Performs telephonic outreach to patient, in-clinic provider, payor and physician when needed, or as requested.
  • Documents all communications with case stakeholders (adjusters, case managers, in-clinic providers.)

Clinical Review

  • Initiates review for requested service upon system referral (or referral from non-clinical staff)
  • Review types include Utilization Review and Continued Authorization (provide documented recommendations to adjusters and Nurse Case Managers based on use of appropriate guidelines.)
  • Reviews each case, and formulates recommendations through use of established medical criteria and clinical judgment and communicates case recommendations and potential appeal options as appropriate.
  • Reviews initial evaluation and all clinical documentation against APTA standards, applicable state regulations and relevant treatment guidelines.
  • If necessary, contacts the treating practitioner for additional information or clarification.
  • If necessary, consults with the Medical / Clinical Director or other licensed health professional in the same licensure category or with the same clinical education as the ordering provider.
  • As identified, conducts ongoing review(s) of active cases regarding the need for continued services or treatment
  • Submits supportive research relevant to peer review and best evidence practice patterns.
  • Documents all pertinent clinical patient / case file information and actions into case notes.
  • Appropriately refers cases for review by a physician, chiropractor, or other peer reviewer as required, providing case documentation and clinical recommendations.
  • Serves as a clinical resource and provides oversight of non-clinical personnel and identifies training needs and communicates to the appropriate supervisor / manager.
  • Complies with all established policies and procedures
  • Attends meetings and trainings.
  • Meets quality management standards.
  • Performs activities within the scope of professional licensure.
  • Completes other duties and projects as assigned.

Qualifications

  • Must be an appropriate health professional and possess an active professional relevant license
  • Professional experience in providing direct patient care
  • Experience in utilization review, case management, quality improvement and/or managed care is desired
  • Excellent verbal and written communication skills
  • Organizational skills, prioritization, problem-solving and decision-making skills are required
  • Ability to multi-task in a fast paced environment
  • Must be computer literate and be able to use the keyboard accurately.
  • Experience with Microsoft Office and review applications is desired

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