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Clinical Reviewer Jobs (NOW HIRING)

Acentra Health

Clinical Reviewer-SCA

Mclean, VA · On-site

The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements. Responsibilities: * Assures accuracy ...

Integrated Home

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 ...

Integrated Home

Clinical Reviewer Nurse

Hollywood, 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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How much do clinical reviewer jobs pay per hour?

As of Jun 30, 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 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 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:
What states have the most Clinical Reviewer jobs? States with the most job openings for Clinical Reviewer jobs include:
What job categories do people searching Clinical Reviewer jobs look for? The top searched job categories for Clinical Reviewer jobs are:
Clinical Reviewer jobs near you
Infographic showing various Clinical Reviewer job openings in the United States as of June 2026, with employment types broken down into 17% As Needed, 8% Full Time, and 75% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.

Clinical Reviewer (Part-time)

Neil Hoosier & Associates, Inc.

Owings Mills, MD • Remote

$40 - $45/hr

Part-time

Posted 27 days ago

Key responsibilities

  • Review submitted prior authorization and pre-payment requests to determine whether documentation is complete, accurate, and compliant with Medicare criteria.

  • Evaluate medical necessity based on relevant National and Local Coverage Determinations and assess clinical evidence provided.

  • Maintain thorough, organized documentation of clinical assessments, rationale, and determinations.

Job description

Pay Range: $40 - $45 per hour based on experience
Work Hours: 20 hours per week (Mon - Fri)
Location:  Remote
Summary:
The Clinical Reviewer is responsible for conducting clinical reviews of submitted prior authorization (PA) requests and pre-payment requests submitted to Fee-For-Service Medicare by Providers and/or Suppliers. The reviewer verifies that each request includes accurate, complete clinical documentation and meets all applicable Medicare coverage, coding, and payment rules, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). This role ensures that determinations are evidence-based, compliant, and aligned with the CMS requirements.
Responsibilities and Duties:
  • Review submitted prior authorization requests and/or pre-payment requests to determine whether required documentation is complete, accurate, and compliant with Medicare criteria.
  • Evaluate medical necessity based on relevant NCDs, LCDs, and Local Coverage Articles as required for each item and/or service assessing clinical evidence provided.
  • Provide clinical justification for affirmation or non-affirmation of accuracy decision
  • Ensure all determinations align with Medicare requirements and CMS model rules
  • Maintain thorough, organized documentation of clinical assessments, rationale, and determinations.
  • Support quality reviews to ensure consistency and accuracy across determinations.
  • Assist with writing review protocols, procedures, workflows, etc
  • Attend required meetings and workgroups as needed to perform independent case reviews (e.g., procedural changes, sharing trends, reviewing information on specific case files, and discussing issues or questions)
  • Meet productivity and quality assurance standards 
  • Work in Project Manager to determine reviewer workload, tasking, and priorities

Qualifications:
  • Licensed clinician (e.g., MD/DO, PA, NP, RN)
  • At least 5 years of professional healthcare experience
  • Working knowledge and understanding of Medicare coverage guidelines and clinical expertise to evaluate the medical necessity determination
  • Medical Coding Certification (ICD-9-CM, ICD-10-CM, CPT-4 and HCPCS) preferred
  • Ability to interpret clinical records, imaging, diagnostic tests, and practitioner notes.
  • Familiarity with CMS prior authorization programs, MAC processes, or pre-payment medical review, preferred
  • Excellent clinical judgement and critical thinking.
  • Strong written and oral communication skills for documenting and communicating determinations.
  • Ability to work in a structured, time-sensitive environment.
  • High attention to detail and accuracy.
  • Proficiency with Microsoft Office Suite such as Outlook, Word, Teams, and Excel, and SharePoint
  • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
  • Must have no conflict of interest (COI) as defined in Section 1154(b)(1) of the Social Security Act (SSA)

NHA is a state and federal government contractor; all employees must be legally authorized to work in the United States. NHA does not provide sponsorship at this time.

NHA is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment based on merit, without regard to race, color, religion, sex, sexual orientation, national origin, veteran status, disability or any other basis protected by law.

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