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 ...
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 ...
$95K - $135K/yr
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 ...
$95K - $135K/yr
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 ...
Contribute to feasibility reviews, study design, and recruitment strategies. * Stay current with clinical research regulations and therapeutic advances. Qualifications * M.D. or D.O. with an active ...
Contribute to feasibility reviews, study design, and recruitment strategies. * Stay current with clinical research regulations and therapeutic advances. Qualifications * M.D. or D.O. with an active ...
Contribute to feasibility reviews, study design, and recruitment strategies. * Provide medical expertise on dermatology-related endpoints and safety monitoring . * Stay current with clinical research ...
Contribute to feasibility reviews, study design, and recruitment strategies. * Provide medical expertise on dermatology-related endpoints and safety monitoring . * Stay current with clinical research ...
Contribute to feasibility reviews, study design, and recruitment strategies. * Provide medical expertise on dermatology-related endpoints and safety monitoring . * Stay current with clinical research ...
Contribute to feasibility reviews, study design, and recruitment strategies. * Provide medical expertise on dermatology-related endpoints and safety monitoring . * Stay current with clinical research ...
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 ...
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 ...
San Juan, PR · On-site
$100 - $230/hr
Clinical Research Cardiologist (Part-Time - 8 hrs./week) Location: San Juan, Dorado, PR Schedule ... Contribute to feasibility reviews and recruitment strategies. * Stay current on GCP regulations and ...
San Juan, PR · On-site
$100 - $230/hr
Clinical Research Cardiologist (Part-Time - 8 hrs./week) Location: San Juan, Dorado, PR Schedule ... Contribute to feasibility reviews and recruitment strategies. * Stay current on GCP regulations and ...
Clinical Research Cardiologist (Part-Time - 8 hrs./week) Location: San Juan, Dorado, PR Schedule ... Contribute to feasibility reviews and recruitment strategies. * Stay current on GCP regulations and ...
Clinical Research Cardiologist (Part-Time - 8 hrs./week) Location: San Juan, Dorado, PR Schedule ... Contribute to feasibility reviews and recruitment strategies. * Stay current on GCP regulations and ...
San Juan, PR · On-site
$110 - $140/hr
Ensure alignment with clinical best practices and cost-containment goals. Collaborate with ... Support the review of the Pharmacy sections of the Medicare Advantage BID and Commercial Policies ...
San Juan, PR · On-site
$110 - $140/hr
Ensure alignment with clinical best practices and cost-containment goals. Collaborate with ... Support the review of the Pharmacy sections of the Medicare Advantage BID and Commercial Policies ...
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
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 ...
$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 ...
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 ...
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 ...
Guaynabo, PR · On-site
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 ...
Guaynabo, PR · On-site
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 ...
Guaynabo, PR · On-site +1
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 ...
Guaynabo, PR · On-site +1
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 ...
Guaynabo, PR · On-site
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 ...
Guaynabo, PR · On-site
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 ...
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 ...
San Juan, PR · On-site
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 ...
San Juan, PR · On-site
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 ...
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 ...
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 ...
Florida, PR · On-site
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 ...
Florida, PR · On-site
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 ...
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.
| Aspect | Clinical Reviewer | Medical Reviewer |
|---|---|---|
| Required Credentials | RN, LPN, or other healthcare licenses; sometimes certifications in case management or clinical review | MD or DO; medical license; often board-certified in a specialty |
| Work Environment | Insurance companies, healthcare organizations, or government agencies; reviewing medical records and claims | Hospitals, clinics, insurance companies; evaluating medical records and providing expert opinions |
| Employer & Industry Usage | Primarily in insurance and healthcare administration | Primarily 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.
The most popular types of Clinical Reviewer jobs in Puerto Rico are:
For Clinical Reviewer jobs in Puerto Rico, the most frequently searched job titles are:
The top searched job categories for Clinical Reviewer jobs in Puerto Rico are:

Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 21 days ago
6.8
Based on 253 frontline employees who took The Breakroom Quiz
494th of 888 rated healthcare providers
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.
Requirements:
Benefit & Rewards Highlights
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:
Benefit & Rewards Highlights
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_TIMEGet the full story on Breakroom
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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.
Health care and social assistance
10,000+ Employees
King of Prussia, PA, US