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Clinical Reviewer Nurse

Miramar, FL · On-site

... are. * Concurrent review of patient's clinical information for efficiency * Ongoing review of precertification requests for medical necessity * Coordinates patient care needs with a multi ...

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Clinical Reviewer information

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$24

$35

$46

How much do clinical reviewer jobs pay per hour?

As of Jul 23, 2026, the average hourly pay for clinical reviewer in the United States is $35.92, according to ZipRecruiter salary data. Most workers in this role earn between $31.25 and $40.38 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 claims or healthcare programs. They often work with healthcare providers and use clinical guidelines to ensure accurate and consistent assessments, typically requiring knowledge of medical terminology and documentation 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 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 to become a clinical nurse reviewer?

To become a clinical nurse reviewer, candidates typically need a registered nurse (RN) license, relevant clinical experience, and knowledge of healthcare policies. Many employers prefer candidates with experience in case review, medical records, or healthcare compliance, and some roles may require certification such as Certified Case Manager (CCM) or similar credentials.

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.

How to become a clinical data reviewer?

To become a clinical data reviewer, candidates typically need a bachelor's degree in a health-related field such as nursing, pharmacy, or life sciences. Relevant experience in clinical research, data management, or regulatory environments is often required, along with knowledge of clinical trial protocols and data analysis tools like EDC systems. Certifications such as Certified Clinical Data Manager (CCDM) can enhance job prospects.
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Clinical Reviewer jobs near you
Infographic showing various Clinical Reviewer job openings in the United States as of July 2026, with employment types broken down into 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.
RN Clinical Reviewer

RN Clinical Reviewer

Greenlife Healthcare Staffing

Jericho, NY • On-site

$60/hr

Other

Medical

Posted 5 days ago

Job description

RN Clinical Reviewer - Jericho or Albany, NY (#25332) Location: Jericho or Albany, NY Employment Type: Full-time, Temp-to-hire (5 days a week) Hourly Rate: $60/hr Position Overview: Greenlife Healthcare Staffing is seeking a meticulous Clinical Reviewer Registered Nurse. This individual will work under the direction of the supervisor of the team performing clinical reviews and abstractions of assigned cases related to a maternal death or to an adverse event that occurred during an outpatient surgical procedure. This temp-to-hire role is ideal for an experienced RN with a strong OB/maternal health background and a passion for quality improvement and patient safety. Why Join Us? Competitive Compensation: Earn a competitive rate of $60 per hour. Comprehensive Benefits: 5 Sick Days (40 hours) subject to the provisions of the NYS Paid Sick Leave Act Health Insurance subject to plan eligibility requirements Work Schedule: Full-time position, 5 days per week, with a temp-to-hire structure. Professional Growth: Gain valuable experience conducting high-stakes clinical reviews for the NYS Department of Health, enhancing your expertise in quality improvement and maternal health. Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes by identifying and analyzing critical events in maternal care and outpatient surgical procedures. Qualifications: Education: Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program. Licensure: Current licensure as a registered professional nurse in New York State. Experience: A minimum of four years of clinical practice experience in a facility or community-based setting, including medical, surgical, and/or obstetrical experience. Minimum of two years of acute care hospital experience. Experience in an acute or ambulatory care healthcare facility reviewing charts for the purpose of quality improvement or utilization review, preferred. Knowledgeable of current disease/care management/coordination trends, preferred. Must have OB/maternal health background. Skills: Strong analytical and communication (both written and verbal) skills. The ability to work independently, as well as in a team environment. The ability to prioritize reviews and projects to be completed. Proficient in the use of standard office technology and basic Microsoft applications including Word and Excel. Ability to gather and analyze information from records, reports, and other sources. Key Responsibilities: Conduct clinical reviews of medical records from a variety of sources as well as other documents crucial to the review as appropriate. Develop and draft narrative summaries of clinical reviews performed in the form(s) required by NYS Department of Health (the Department). Track case status in Excel and other databases as required by the Department. Other activities as may be deemed necessary in response to the changing needs of the department. Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives
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About Greenlife Healthcare Staffing

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Greenlife Healthcare Staffing is a nationwide recruitment agency, matching both new grads and advanced practitioners to hospitals, clinics, nursing homes, multi-specialty groups, and private practices.

Industry

Recruiting and staffing services

Company size

11 - 50 Employees

Headquarters location

New York, NY, US

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