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Clinical Reviewer Jobs in Michigan (NOW HIRING)

Archdiocese of Detroit

Clinical Therapists

Southfield, MI · On-site

$54K - $73K/yr

... reviews of client progress, and any other compliance issue required of the program and its personnel. Direct Clinical Activities: • Provide individual clinical assessments, diagnosis, treatment ...

Archdiocese of Detroit

Clinical Therapists

Southfield, MI

$54K - $73K/yr

... reviews of client progress, and any other compliance issue required of the program and its personnel. Direct Clinical Activities: • Provide individual clinical assessments, diagnosis, treatment ...

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How much do clinical reviewer jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for clinical reviewer in Michigan is $31.30, according to ZipRecruiter salary data. Most workers in this role earn between $27.26 and $35.19 per hour, depending on experience, location, and employer.

What is a clinical reviewer?

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.

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 skills are required for a clinical reviewer?

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 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 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.

More about Clinical Reviewer jobs

What are the most commonly searched types of Clinical Reviewer jobs in Michigan?

The most popular types of Clinical Reviewer jobs in Michigan are:

What are popular job titles related to Clinical Reviewer jobs in Michigan?

For Clinical Reviewer jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Clinical Reviewer jobs in Michigan look for?

The top searched job categories for Clinical Reviewer jobs in Michigan are:

What cities in Michigan are hiring for Clinical Reviewer jobs?

Cities in Michigan with the most Clinical Reviewer job openings:

Clinical Reviewer jobs near you
Infographic showing various Clinical Reviewer job openings in Michigan as of August 2026, with employment types broken down into 82% Full Time, 10% Part Time, and 8% Contract. Highlights an 87% In-person, and 13% Remote job distribution, with an average salary of $65,114 per year, or $31.3 per hour.

Remote Clinical Review Pharmacist

Detroit, MI • On-site

Pharmacy Careers
See more jobs at Pharmacy Careersexternal

$108K - $129K/yr

Other

Posted 16 days ago

Job description

Remote Clinical Review Pharmacist – Work From Home

Leverage your clinical knowledge in a fully remote Clinical Review Pharmacist role. Evaluate prescriptions and treatment plans for safety, appropriateness, and cost-effectiveness while working from home.

Key Responsibilities

  • Review prescriptions, treatment plans, and clinical requests for appropriateness, safety, and value.
  • Apply clinical guidelines and evidence-based standards to support determinations.
  • Collaborate with physicians, nurses, and utilization-management teams on complex cases.
  • Document recommendations and decisions according to health-plan and regulatory requirements.
  • Participate in quality initiatives and peer-to-peer discussions as needed.

What You'll Bring

  • Education: PharmD or Bachelor of Pharmacy.
  • Licensure: Active, unrestricted U.S. pharmacist license.
  • Experience: Clinical review, utilization management, or managed care preferred. Hospital, ambulatory, and community pharmacists with strong clinical judgment are highly encouraged to apply.
  • Skills: Excellent clinical writing, critical thinking, and communication.

Why This Role?

  • 100% remote with flexible scheduling.
  • Help patients access safe, effective, and affordable medications.
  • Develop specialized expertise in managed care and utilization review.
  • Competitive compensation, full benefits, and advancement opportunities.

About Us We are a confidential healthcare organization providing managed-care and pharmacy review services across the U.S. Our pharmacists ensure the right medication reaches the right patient at the right time.

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