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Clinical Reviewer Jobs (NOW HIRING)

IPRO

Clinical Reviewer (RN)

Jericho, NY · On-site

$38.46 - $43.27/hr

Clinical Reviewer (RN) As a Clinical Reviewer (RN), you will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. You will utilize your knowledge and ...

IPRO

Clinical Reviewer RN (Proofer)

Jericho, NY · On-site

$36.06 - $43.27/hr

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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$24

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$46

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:
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What states have the most Clinical Reviewer jobs? States with the most job openings for Clinical Reviewer jobs include:
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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.
Behavioral Health Clinical Reviewer

Behavioral Health Clinical Reviewer

Nexus Health Systems

Houston, TX • On-site

Other

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

Nexus Health Systems rating

6.3

Company rating: 6.3 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Behavioral Health Clinical Reviewer

The Behavioral Health Clinical Reviewer is responsible for evaluating clinical records and referral documentation to determine eligibility and fit for Nexus behavioral health and neurodevelopmental programs. This role involves preparing high-quality clinical evaluations and summaries that meet payer requirements, including insurance and Medicaid standards. The reviewer ensures admissions decisions are made efficiently, accurately, and in compliance with regulatory, clinical, and Nexus program guidelines.

Key Responsibilities

Referral & Record Review

  • Review incoming referral packets, medical and clinical histories, assessments, and related documentation.
  • Determine program appropriateness for behavioral health, autism, intellectual/developmental disabilities, and medically complex cases.

Funder & Payer Compliance

  • Maintain up-to-date knowledge of insurance and Medicaid documentation standards.
  • Draft clinical documentation that addresses payer expectations and anticipates potential questions or objections.

Collaboration & Communication

  • Partner with referral sources, families, and internal teams to clarify information and obtain missing documentation.
  • Clearly communicate admission decisions and next steps.

Timeliness & Quality

  • Process referrals and evaluations promptly while maintaining clinical accuracy and compliance.
  • Balance efficiency with quality, ethics, and thoroughness.

Continuous Learning & Improvement

  • Stay current on behavioral health conditions, neurodevelopmental disorders, and medical complexities.
  • Monitor evolving payer policies, assessment tools, and evidence-based practices.
Qualifications

Education

  • Master's degree in Social Work, Clinical Psychology, Counseling, Applied Behavior Analysis, or a related behavioral health field; or Bachelor's degree in Nursing.
  • Doctoral degree (PhD, PsyD, DSW) preferred but not required.

Experience

  • Minimum 3 years of clinical experience in behavioral health, developmental disabilities, or autism spectrum disorders.
  • Proven experience writing clinical assessments/evaluations for payer or insurance approval.
  • Familiarity with private insurance and Medicaid authorization processes.
  • Experience collaborating with interdisciplinary clinical teams.

Licensure/Certification

  • Active clinical license (e.g., LCSW, LPC, LMFT, BCBA, RN, Psychologist) OR eligibility to obtain licensure in Texas.

Skills & Attributes

  • Exceptional written communication skills, with ability to draft clear, concise, and persuasive clinical narratives.
  • Strong interpersonal skills with the ability to work compassionately with families, clinicians, and referral partners.
  • High attention to detail and strong critical thinking.
  • Ability to prioritize, multi-task, and meet deadlines in a fast-paced setting.
  • Proficiency with EMR and CRM systems.

Apply