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Clinical Reviewer Jobs in Puerto Rico (NOW HIRING)

PR · On-site

The Clinical Manager (CLM) of the Behavioral Health Contact Center is responsible for the depth of ... Provide backup to Utilization Review Department out of business hours including document in the ...

The Clinical Manager (CLM) of the Behavioral Health Contact Center is responsible for the depth of ... Provide backup to Utilization Review Department out of business hours including document in the ...

Assists in the development, review, revision, and roll out of clinical policies and procedures and/or education materials; including training and monitoring the implementation of clinical P&P in the ...

Clinical Outlier Support: * Collaborate with leadership to align on priority clinics not meeting ... These must be reviewed with management. However, in general, the position requires the following ...

Performs clinical study site management/monitoring activities in compliance with ICH-GCP, Sponsor ... Collects, reviews, and monitors required regulatory documentation for study start-up, study ...

New

$41K - $78K/yr

Provide in-person clinical case support in cath labs and hospitals, ensuring proper use of Boston ... be reviewed at www.bscbenefitsconnect.com. Actual compensation will be commensurate with ...

Case Review Representative

Guaynabo, PR · On-site +1

$13 - $15/hr

About the Role The Case Review Representative serves as a one-stop shop and intake of all calls ... Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation ...

About the Role The Case Review Representative serves as a one-stop shop and intake of all calls ... Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation ...

About the Role The Case Review Specialist ensures that case documentation is provided by the ... Process cases and request/maintain clinical documentation and transmit timely determinations via ...

About the Role The Case Review Specialist ensures that case documentation is provided by the ... Process cases and request/maintain clinical documentation and transmit timely determinations via ...

Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance. * Collaborates with providers to assess ...

Showing results 21-40

Clinical Reviewer information

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.

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

The most popular types of Clinical Reviewer jobs in Puerto Rico are:

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

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

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

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

Infographic showing various Clinical Reviewer job openings in Puerto Rico as of August 2026, with employment types broken down into 3% As Needed, 74% Full Time, 16% Part Time, and 7% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

CLINICAL MANAGER

UHS

PR • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 21 days ago


Universal Health Services rating

6.8

Company rating: 6.8 out of 10

Based on 253 frontline employees who took The Breakroom Quiz

494th of 888 rated healthcare providers


Job description

Responsibilities

FHCHS of PR, Inc. organization with extensive experience in managing mental health benefits and developing solutions that promote the emotional well-being of individuals, families, workplaces, and communities. Since our foundation in 1996, at FHC Mental Health, we have worked to facilitate access to excellent mental health services and support people at different stages of their lives.  Our experience has allowed us to evolve, expand our services, and develop integrated solutions that promote prevention, guidance, recovery, and continuity of care.  Website: https://fhcsaludmental.com/ 

The Clinical Manager (CLM) of the Behavioral Health Contact Center is responsible for the depth of the clinical interventions with people that require telephone counseling. CLM is responsible for crisis and emergency management and recommends the alternate care levels leading to a rehabilitation plan.  Establish direct communication with leaders and representatives of the Behavioral Health Contact Center, with people within FHC, mental health clinics, and with the divisions of the integrated system to guarantee the continuity of care. Consults with psychiatrists the more complex cases. Offers support to Case Managers and to all the efforts related to complying with handling the phone calls. The Clinical Manager is responsible for telephonic counseling, managing referrals and providing support in the coordination and notification of appointments scheduled for our members, in accordance with the timeframes established in the organization's policies. This role also ensures accessibility and quality of care for our members.

  1.  Counsels and provide support in the training or retraining process to new staff, if required.
  2. Attends and participates in the assigned meetings.
  3. Gathers the data and information requested for the preparation of reports of services and tendencies.
  4. Fulfills satisfactorily the objectives and task delegated within the established time.
  5. Identifies and reports relevant matters to the Behavioral Health Contact Center Director or her assignee.
  6. Complies with the established attendance and punctuality policy.
  7. Applies in a consistent manner the policies and procedures that are pertinent to the Behavioral Health Contact Center at FHC.
  8. Maintains professional conduct, follows the code of conduct, and maintains a therapeutic relationship with the patients and their relatives, according to the policies established at the institution.
  9. Faithfully comply with all policies and procedures of the Company and all requirements of our customers.
  10. No provides business information or material to our competitors or any other client.
  11. Agree to comply faithfully with the following requirements, but not limited to: Code of Conduct, Ethics, Confidentiality, Conflict of Interest, etc.
  12. Receives and verifies the referral for the coordination of appointments and requests additional information, if necessary.
  13. Timely coordination of care for members and dependents is essential.
  14. Issue authorizations for services coordinated and inform members/dependents.
  15. Notify the relevant parties of any coordinated appointments that may be necessary.
  16. Provide backup to Utilization Review Department out of business hours including document in the appropriate platform services request, provide information of service request status, provide information of operational hours, orient about the appointment of representative process, close previously authorized services and send notifications to providers, among others.
  17. Participate in a new project as assigned by the supervisor or director.

Qualifications

Requirements: 

  • Master’s in social work, Psychology, Psychological Counseling, Mental Health Counseling, or Psychiatric Nursing
  • Valid and current active license for Social Work, Psychiatric Nursing, Psychological Counseling, Psychology, or Mental Health Counseling
  • Professional associating membership (colegiación): valid membership for Social Work and Psychiatric Nursing
  • Two or more years of experience in the health field.
  • Knowledge in Microsoft Office
  • Preferred fully bilingual

 Benefit & Rewards Highlights 

  • Competitive Compensation
  • Excellent Medical, Dental, Vision and Prescription Drug Plans 
  • 401(K) with company match
  • Career development opportunities within UHS and its 300+ Subsidiaries! 
  • Tuition incentive
  • Continuing education incentive
  • Vacation and sick license, among others.

About Universal Health Services 

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues  during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.  

Headquarters in King of Prussia, PA, UHS has approximately 101,500 employees and continue to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com. 

EEO Statement 

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. 

Avoid and Report Recruitment Scams 

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. 

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. 

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters. 

Qualifications:

Requirements: 

  • Master’s in social work, Psychology, Psychological Counseling, Mental Health Counseling, or Psychiatric Nursing
  • Valid and current active license for Social Work, Psychiatric Nursing, Psychological Counseling, Psychology, or Mental Health Counseling
  • Professional associating membership (colegiación): valid membership for Social Work and Psychiatric Nursing
  • Two or more years of experience in the health field.
  • Knowledge in Microsoft Office
  • Preferred fully bilingual

 Benefit & Rewards Highlights 

  • Competitive Compensation
  • Excellent Medical, Dental, Vision and Prescription Drug Plans 
  • 401(K) with company match
  • Career development opportunities within UHS and its 300+ Subsidiaries! 
  • Tuition incentive
  • Continuing education incentive
  • Vacation and sick license, among others.

About Universal Health Services 

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues  during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.  

Headquarters in King of Prussia, PA, UHS has approximately 101,500 employees and continue to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com. 

EEO Statement 

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. 

Avoid and Report Recruitment Scams 

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. 

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. 

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters. 

Education:UNAVAILABLEEmployment Type: FULL_TIME

What Universal Health Services employees say

Pay

Benefits

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Universal Health Services logo

About Universal Health Services

Sourced by ZipRecruiter

Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

King of Prussia, PA, US