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Clinical Reviewer Jobs (NOW HIRING)

... 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 ...

Clinical Reviewer RN (Proofer) In the Clinical Reviewer RN (Proofer) role, you will review all NYS Dispute Resolution and External Review determinations for accuracy of decisions, mathematical ...

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Clinical Reviewer information

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How much do clinical reviewer jobs pay per hour?

As of Jun 7, 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.

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.

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 cities are hiring for Clinical Reviewer jobs? Cities with the most Clinical Reviewer job openings:
What are the most commonly searched types of Clinical Reviewer jobs? The most popular types of Clinical Reviewer jobs are:
Who are the top companies hiring for Clinical Reviewer jobs? The top employers for Clinical Reviewer jobs are:
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Surgical Clinical Reviewer

Surgical Clinical Reviewer

RWJBarnabas Health

Livingston, NJ • On-site

$58K - $78K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.


RWJBarnabas Health rating

7.6

Company rating: 7.6 out of 10

Based on 322 frontline employees who took The Breakroom Quiz

185th of 869 rated healthcare providers


Job description

Job Title: Surgical Clinical Reviewer

Location: Cooperman Barnabas Medical Ctr

Department Name: Department of Surgery

Req #: 0000238249

Status: Salaried

Shift: Day

Pay Range: $58,000.00 - $78,000.00 per year

Pay Transparency:

The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

Job Overview:

The Surgical Clinical Reviewer s chief responsibility is to collect and submit reliable data to the ACS NSQIP,

This is accomplished through high-quality data compilation, documentation and entry into the ACS NSQIP database of all eligible surgeries for the hospital.The SCR works closely with the members of the Department of Surgery to identify opportunities for clinical quality improvement (QI), patient safety (PS) initiatives, and other special projects as may be identified. The SCR will also be responsible for assisting surgical residents in identifying and initializing QI and PS research projects,

Qualifications:

Required

  • Master's level degree in a health care related field.

  • Ability to complete all training modules and pass the ACS NSQIP certification examination,

Preferred:

  •  Minimum one year experience in hospital surgery department, surgery clinic, clinical research or medical records,

  • Contact with Others: Administrators, physicians, residents, students, hospital personnel, patients/patient families

  • Computer and Internet experience required — familiarity and comfort with MS Office products is essential for success in this position (Word and Excel- required; PowerPoint and Access preferred).

Scheduling requirements:

  • Full time days

  • Fully remote in New Jersey.

Essential Functions:

  • Identifies surgical patients for inclusion in the Program through the application of Program inclusion/exclusion criteria and protocols.

  •  Collects preoperative, operative, and postoperative data components for the Program through the effective utilization of the hospital medical record systems.

  • Attends weekly Quality Improvement (Morbidity & Mortality, Tumor Board, etc.) conferences to ensure reliable data collection of postoperative occurrences.

  • Demonstrates applicability of the methodology and the reliability of definitions utilized by reviewers within the Program through Inter-Rater Reliability (IRR) testing

  •  Identifies streamlining and process improvement opportunities in the data collection process.

  • Demonstrates appropriate utilization of resources necessary to obtain valid, reliable data for entry into the Program

  •  Establishes effective working relationships with members of the hospital community, especially staff in the Surgery, Medicine, Nursing, Health Information Management and the Information Systems Departments whose support is necessary for the management and success of the Program.

  • Contacts patients and/or families via telephone and/or written communications postoperatively for the purpose of identifying possible occurrences associated with surgical procedures performed at the hospital.

  • Serves as an educational resource on the ACS NSQIP for internal and external audiences by developing educational material and delivering presentations.

  •  Successfully completes the ACS NSQIP SCR Training/Certification Program.

  • Participates in Program teleconferences. Attends ACS NSQIP National Conference.

Benefits and Perks:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to supports our employees’ physical, emotional, social, and financial health.

  • Paid Time Off (PTO)

  • Medical and Prescription Drug Insurance

  • Dental and Vision Insurance

  • Retirement Plans

  • Short & Long Term Disability

  • Life & Accidental Death Insurance

  • Tuition Reimbursement

  • Health Care/Dependent Care Flexible Spending Accounts

  • Wellness Programs

  • Voluntary Benefits (e.g., Pet Insurance)

  • Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer


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About RWJBarnabas Health

Sourced by ZipRecruiter

RWJBarnabas Health is New Jersey’s largest integrated health care delivery system, providing treatment and services to more than three million patients each year. Throughout RWJBarnabas Health, our dedicated physicians, nurses, and health professionals are committed to providing the highest quality of patient care and health education to the community and region. We aim to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey - whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

West Orange, NJ, US

Year founded

2015