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Clinical Reviewer Jobs (NOW HIRING)

Comagine

Clinical Reviewer RN - Alabama

Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality ...

Cohere Health

Clinical Reviewer, Physician Assistant

$120K - $135K/yr

Clinical Reviewer, Physician Assistant We are looking for an orthopedic spine Physician Assistant to help deliver on Cohere's musculoskeletal and orthopedic programs by determining the medical ...

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Clinical Reviewer information

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How much do clinical reviewer jobs pay per hour?

As of Jul 24, 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.
More about Clinical Reviewer jobs
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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 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 (Proofer)

RN Clinical Reviewer (Proofer)

GreenLife Healthcare Staffing

Jericho, NY

$45/hr

Other

Medical

Posted 13 days ago

Job description

RN Clinical Reviewer (Proofer) - Jericho, NY (#25289)

Location: Jericho, NY
Employment Type: Full-time, Temp-to-Hire
Hourly Rate: $45/hr

About Greenlife Healthcare Staffing:

Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Position Overview:

Greenlife Healthcare Staffing is seeking a meticulous Clinical Reviewer Proofer Registered Nurse who will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. They will utilize their knowledge and expertise of the review program to conduct clinical-level review, supporting Medical Review Analysts and Physician Consultants to ensure an appropriate and accurate process.

Why Join Us?

  • Competitive Compensation: Earn $45 per hour.
  • Comprehensive Benefits:
    • Paid Sick Time
    • Health insurance
    • Benefits from Paychex, such as Payactiv
    • GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc.
  • Work Schedule: Full-time (5 days per week), Temp-to-Hire position.
  • Professional Growth: Gain valuable experience in a collaborative, innovative, and supportive environment, enhancing skills in clinical review.
  • Impactful Work: Play a critical role in ensuring the accuracy and integrity of state-level healthcare dispute resolutions.

Qualifications:

  • Education: Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York.
  • Licensure: Must have an active NY State RN license.
  • Experience: Must have a minimum of 2 years experience in an acute care facility, preferably in medicine/surgery or special care units, and/or 1 to 3 years experience in acute care utilization review.
  • Technical Skills: Knowledge and experience with electronic medical records, including coding, quality, and clinical charting.
  • Soft Skills: 
    • Ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
    • Excellent written and verbal skills.
    • Ability to work independently with little supervision.
    • Ability and desire to be flexible, innovative, and creative

Key Responsibilities:

This individual will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. They will utilize their knowledge and expertise of the review program to conduct clinical-level review, supporting Medical Review Analysts and Physician Consultants to ensure an appropriate and accurate process.

  • Conduct utilization reviews up to and including the appeal level. This includes the chart screen, complete electronic worksheets, entering required information, and making level one denial decisions when necessary.
  • Conduct quality and clinical study data collection reviews. This includes a chart review, complete detailed electronic data worksheets.
  • Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles.
  • Participate in collaborative training specific to clinical study objectives.
  • Other activities as may be deemed necessary.

How to Apply: If you are a detail-oriented RN ready to take the next step in your career, we want to hear from you! Submit your Resume/CV and a writing sample to hr@glhstaffing.com or call our office at (800) 608-4025 to learn more about this opportunity.

Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives

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About Greenlife Healthcare Staffing

Sourced by ZipRecruiter

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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