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Clinical Reviewer Jobs in Remote, OR (NOW HIRING)

Bausch + Lomb

Director, Clinical Development

OR · On-site +1

$75K - $102.20K/yr

Position Overview The Director, Clinical Development will serve as Clinical Lead for assigned ... Ongoing performance feedback and annual compensation review This position may be available in the ...

Amedisys, Inc.

RN Clinical Manager

Roseburg, OR · On-site

$90K - $110K/yr

Reviews requests for services and determines patient eligibility/suitability for home care services ... Assists clinicians in establishing immediate and long-term patient goals, setting priorities and ...

Amedisys, Inc.

RN Clinical Manager

Roseburg, OR

$90K - $110K/yr

Reviews requests for services and determines patient eligibility/suitability for home care services ... Assists clinicians in establishing immediate and long-term patient goals, setting priorities and ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105.34K/yr

Perform clinical assessments and prior authorizations to determine medical necessity * Escalate ... review or case management experience in managed care * Oregon residency and license * Bilingual or ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105.34K/yr

Perform clinical assessments and prior authorizations to determine medical necessity * Escalate ... review or case management experience in managed care * Oregon residency and license * Bilingual or ...

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Clinical Reviewer information

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$24

$35

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How much do clinical reviewer jobs pay per hour?

As of May 28, 2026, the average hourly pay for clinical reviewer in Remote, OR is $35.88, according to ZipRecruiter salary data. Most workers in this role earn between $31.20 and $40.34 per hour, depending on experience, location, and employer.

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 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 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.

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 Remote, OR? The most popular types of Clinical Reviewer jobs in Remote, OR are:
What are popular job titles related to Clinical Reviewer jobs in Remote, OR? For Clinical Reviewer jobs in Remote, OR, the most frequently searched job titles are:
What job categories do people searching Clinical Reviewer jobs in Remote, OR look for? The top searched job categories for Clinical Reviewer jobs in Remote, OR are:
What cities near Remote, OR are hiring for Clinical Reviewer jobs? Cities near Remote, OR with the most Clinical Reviewer job openings:
Clinical Reviewer jobs near you
Infographic showing various Clinical Reviewer job openings in Remote, OR as of May 2026, with employment types broken down into 6% As Needed, 46% Full Time, 42% Part Time, and 6% Contract. Highlights an 50% Physical, 4% Hybrid, and 46% Remote job distribution, with an average salary of $74,633 per year, or $35.9 per hour.

REMOTE Utilization Review Nurse - Managed Care

DOCS Management Services

Coos Bay, OR • Remote

$35.29 - $47.37/hr

Full-time, Part-time

Medical

Posted 11 days ago

Job description

We are currently hiring a Part-time REMOTE Utilization Review Nurse! If you are a licensed nurse with excellent critical thinking skills, have experience in acute care settings and utilization review, and value being part of a team that makes a difference, you may be the right person for the position! Apply today!

Classification: NON-EXEMPT | Status amp; Schedule: PART-TIME, 20-HRS/WEEK, GENERALLY MONDAY – FRIDAY, BUT MAY INCLUDE ADDITIONAL HOURS TO MEET THE NEEDS OF THE POSITION
Location: REMOTE, LOCAL TO OREGON STRONGLY PREFERRED
Work Location: OR, CA, AZ, TX, FL
Salary: $35.29 - $47.37/HOURLY
Department: MEDICAL SERVICES/UTILIZATION REVIEW | Reports to: DIRECTOR OF MEDICAL SERVICES | Supervision Exercised: NON-SUPERVISORY
JOB PURPOSE: Utilization Review Nurse
The Clinical Review Nurse is responsible for providing clinically efficient and effective utilization management. Reviews prior authorization requests for appropriate care and setting by following evidence based clinical guidelines, medical necessity criteria and health plan guidelines. Reviews and applies hierarchy of criteria to all referral and preauthorization requests from the PCP's and specialists that require a medical necessity determination. Is involved in assuring that the patient receives high-quality cost-effective care. Uses sound clinical judgement and managed care principles in the coordination of care. Prepares any case that does not meet medical necessity guidelines for medical appropriateness of procedure, service, or treatment for review with the Physician Reviewer for a decision.
QUALIFICATIONS, EDUCATION, and EXPERIENCE
  • Nursing degree from an accredited nursing program
  • Unrestricted Oregon RN license
  • Experience with a similar population in health plans or managed care
  • Experience administering OHP, Medicare benefits or utilization review highly preferred.
ESSENTIAL RESPONSIBILITIES: Licensed Utilization Review
  1. Maintains clinical expertise and knowledge of scientific progress in nursing and medical arena and incorporates this information into the clinical review and care coordination processes
  2. Performs clinical review for appropriate utilization of medical services by applying appropriate medical necessity criteria guidelines
  3. Authorizes healthcare services in compliance with contractual agreements, Health Plan guidelines and appropriate medical necessity criteria
  4. Provides accurate and timely documentation within internal system supporting rational of decision based on clinical review
  5. Identifies members who are appropriate for care coordination programs and collaborates with the Medical Management team for care coordination of the member's needs along the continuum of care
  6. Meets timeliness standards for referral and prior authorization activities
  7. Sends appropriate notifications for Third Party Liability (TPL) and/or possible Stop Loss
  8. Forward relevant information of members requiring special interventions to Advanced Health
  9. Participate in quality and organizational process improvement activities and teams when requested
  10. Assist in audit preparation as directed
  11. Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
  12. Handle confidential information and materials appropriately and maintains a secure work area
  13. Maintains the confidentiality of all company procedures, results, and information about patients, contracts, and all other proprietary information regarding company business.
  14. Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
  15. Handle confidential information and materials appropriately and maintain a secure work area
  16. Other duties as assigned
ESSENTIAL RESPONSIBILITIES: ORGANIZATIONAL TEAM MEMBER
  • Participate in quality and organizational process improvement activities and teams when requested
  • Support and contribute to effective safety, quality, and risk management efforts by adhering to established; policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities
  • Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner
  • Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization
  • Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations
  • Recognize new developments and remain current in [position’s expertise] best practice standards and anticipate organizational modifications
  • Advance personal knowledge base by pursuing continuing education to enhance professional competence
  • Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
  • Represent organization at meetings and conferences as applicable
KNOWLEDGE, SKILLS, and ABILITIES
  • Knowledge of OHP program requirements, benefit package, eligibility categories, and Oregon Division of Medical Assistance Program (MAP) rules and regulations preferred
  • Knowledge of ICD, CPT, and HCPCS codes
  • Proficient in Milliman Clinical Guidelines (MCG)
  • Strong attention to detail
  • Ability to think and work independently with minimum supervision
  • Provide critical attention to detail for accuracy and timeliness
  • Ability to manage multiple tasks and remain flexible in a dynamic work environment
  • Ability to report to work as scheduled, and willingness to work a flexible schedule when needed
  • Proficient in Microsoft Office Suite and Windows Operating System (OS)
  • Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access
  • Knowledge and understanding of how the positions’ responsibilities contribute to the department and company goals and mission
  • Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
  • Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices
  • Excellent people skills and friendly demeanor
  • Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
  • Attention to detail and organization skills
  • Ability to handle stress and sensitive situations effectively while projecting a professional attitude
  • Ability to communicate professionally, both conversing and written
  • Ability to work with diverse populations and interact with people of differing personalities and backgrounds
  • Sensitive to economic considerations, human needs and aware of how one’s actions may affect others
  • Ability to organize and work in a sensitive manner with people from other cultures
  • Poised; maintains composure and sense of purpose
WORKING CONDITIONS
This position must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information.
Work Condition: Remote Work Environment
  • Employee generally works within a remote work from home environment.
  • Travel may be required on occasion.
  • Hours of operations and specific staff scheduling may vary based on operational need.
Exposed to:
  • Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output.
  • Machines, equipment, tools, and supplies used: Constantly operates a computer or other office productivity machinery or software, such as fax, copier, calculator, multi-line telephone system, or scanner.
  • May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information.
Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task.
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of DOCS Management Services employees. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

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