ZipRecruiter

Log In

1

Clinical Reviewer Jobs in Reston, VA (NOW HIRING)

URAC

Clinical Accreditation Reviewer

Washington, DC · On-site

$120K - $135K/yr

MAJOR PURPOSE OF THIS JOB: The Accreditation Reviewer is an expert in the content and ... of clinical experience and three (3) years of managed care experience to include one of the ...

New

Commence

Clinical Medical Director

Leesburg, VA · On-site

$80K - $110K/yr

Review and adjudicate complex medical necessity, coding, and billing disputes involving out-of-network claims * Develop and maintain clinical review protocols, decision frameworks, and quality ...

next page

Showing results 1-20

All JobsClinical Reviewer JobsClinical Reviewer Jobs in Reston, VA

Clinical Reviewer information

See Reston, VA salary details

$25

$37

$48

How much do clinical reviewer jobs pay per hour?

As of Jun 13, 2026, the average hourly pay for clinical reviewer in Reston, VA is $37.37, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $42.02 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 companies or healthcare organizations. They ensure that clinical guidelines are followed and may use electronic health record systems and medical coding tools as part of their work. Strong knowledge of medical terminology and healthcare regulations is essential for this role.

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 do you become a medical reviewer?

To become a clinical reviewer, candidates typically need a medical degree such as an MD or DO, along with clinical experience in a relevant specialty. Additional qualifications often include knowledge of healthcare regulations, strong analytical skills, and familiarity with medical records and documentation; some roles may require certification or training in medical review processes.

What jobs pay 2000 a day?

Clinical reviewers typically do not earn $2,000 a day; their salaries are usually based on annual or hourly rates. High-paying roles in healthcare or consulting, such as specialized physicians, senior consultants, or executive-level positions, can reach or exceed this daily rate, often requiring advanced certifications, extensive experience, and a high level of expertise.

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.
More about Clinical Reviewer jobs
What are popular job titles related to Clinical Reviewer jobs in Reston, VA? For Clinical Reviewer jobs in Reston, VA, the most frequently searched job titles are:
What job categories do people searching Clinical Reviewer jobs in Reston, VA look for? The top searched job categories for Clinical Reviewer jobs in Reston, VA are:
What cities near Reston, VA are hiring for Clinical Reviewer jobs? Cities near Reston, VA with the most Clinical Reviewer job openings:
Clinical Reviewer jobs near you
Infographic showing various Clinical Reviewer job openings in Reston, VA as of June 2026, with employment types broken down into 91% Full Time, and 9% Part Time. Highlights an 73% In-person, 9% Hybrid, and 18% Remote job distribution, with an average salary of $77,722 per year, or $37.4 per hour.
Clinical Accreditation Reviewer

Clinical Accreditation Reviewer

URAC

Washington, DC • On-site

$120K - $135K/yr

Full-time

Posted yesterday

Job description

Description:

MAJOR PURPOSE OF THIS JOB: The Accreditation Reviewer is an expert in the content and interpretation of accreditation programs and standards. Primary responsibilities include analyzing accreditation application documentation and conducting validation reviews. Key additional responsibilities include participating in the standards development/revision process, providing educational instruction, and responding to inquiries related to interpretation of the accreditation standards.

JOB DUTIES AND RESPONSIBILITIES:

Conducts all aspects of accreditation reviews, including:

•Manages the client relationship as the primary point of contact for assigned applications

•Communicates with applicants utilizing positive customer relation skills

•Serves as a technical expert for accreditation program and standard content and interpretation

•Conducts Desktop Review of applications including analyzing submitted documentation in accordance with URAC scoring methodology, providing constructive written feedback for areas of non-compliance and discussing findings with the applicants in an educational manner

•Conducts onsite and/or virtual Validation Reviews

•Documents and presents findings of applications to Accreditation Committees

•Assists in providing technical support and advice to URAC Accreditation and Standards Committees including supporting the accreditation standards development/revision process

•Assists in the development of program guides, educational workshop and webinar content, validation review tools, and other resources that facilitate consistent interpretation and application of program standards

•Serves in the role of an educator for standards educational workshops and webinars

•Assists in providing technical support for Research & Development, Sales & Marketing, and other URAC department as requested

•Participates in the development, testing, and deployment of information support systems for the Accrediting & Client Services Department

•Other duties as assigned


Requirements:

PHYSICAL REQUIREMENTS:

•Requires extensive travel (70-80%)

•Sedentary work in an office environment, moderate lifting (30 lbs. to 50 lbs.)

•Visually inspect surroundings, written materials and electronic media

•The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

EXPERIENCE, KNOWLEDGE, AND SKILL REQUIREMENTS:

•Advanced reasoning, analysis, language ability (reading, writing and speaking)

•Excellent written and verbal communication and presentation skills

•Ability to communicate effectively and work collaboratively with colleagues, other healthcare professionals, clients and other stakeholders

•Exceptional organizational skills

•Ability to work independently

•Strong negotiation, critical thinking, and problem-solving skills

•Ability to handle conflict and to exercise sound judgment

•Cognitive and interpersonal flexibility

•Computer skills required include Windows Operating System Microsoft Software; Excel, Word, and PowerPoint

•A valid US passport and valid driver’s license is required

EDUCATION AND TRAINING REQUIREMENTS:

•For care management accreditation programs (i.e., utilization management, case management, health call center, and disease management) - registered Nurse with a bachelor’s degree in a health-related field (Master’s Degree preferred).

•Minimum of five (5) years of clinical experience and three (3) years of managed care experience to include one of the following: utilization management, case management, discharge planning, disease management, health call center, independent review, quality management, accreditation, or a related managed care function.

LICENSURE/BOARD CERTIFICATION REQUIREMENTS:

•A current license as a registered nurse in a state in the United States is required.

•For Case Management and Disease Management Accreditation, certification in case management is preferred.