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Full Time Remote Clinical Reviewer Jobs in Raleigh, NC

Centene

Psychologist Reviewer

Durham, NC · On-site +1

$87K - $157K/yr

Centene is Hiring - Remote Psychologist Reviewers (ABA) Centene is seeking Remote Psychologist ... Be part of a collaborative, supportive team committed to clinical excellence Position Purpose:

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Full Time Remote Clinical Reviewer information

See Raleigh, NC salary details

$23

$34

$45

How much do full time remote clinical reviewer jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for full time remote clinical reviewer in Raleigh, NC is $34.91, according to ZipRecruiter salary data. Most workers in this role earn between $30.38 and $39.28 per hour, depending on experience, location, and employer.

What is a full time remote clinical reviewer?

A Full Time Remote Clinical Reviewer is a healthcare professional, often a nurse or physician, who evaluates medical records and clinical documentation from a remote location. Their primary role is to assess the medical necessity, appropriateness, and quality of healthcare services provided to patients, ensuring compliance with regulatory and insurance guidelines. They typically work for insurance companies, healthcare providers, or third-party review organizations. By working remotely, they can access digital medical records and communicate with other healthcare professionals through secure online systems. This role helps improve patient care, streamline billing processes, and reduce unnecessary medical costs.

What are the key skills and qualifications needed to thrive as a full time remote clinical reviewer?

To thrive as a Full Time Remote Clinical Reviewer, you need a solid background in healthcare, clinical assessment, and medical terminology, typically supported by a valid clinical license such as RN, LPN, or similar. Familiarity with utilization management software, electronic health record (EHR) systems, and relevant certifications like URAC or InterQual is often required. Strong attention to detail, critical thinking, and effective written communication are crucial soft skills for this role. These skills ensure accurate clinical evaluations, regulatory compliance, and clear communication in a remote work environment, directly impacting patient outcomes and organizational efficiency.

How does a full time remote clinical reviewer typically collaborate with healthcare providers and team members while working remotely?

As a Full Time Remote Clinical Reviewer, you will regularly collaborate with physicians, nurses, and administrative staff through secure digital platforms such as email, video conferencing, and electronic health record (EHR) systems. Effective communication is essential to clarify case details, obtain additional documentation, and ensure reviews meet compliance and quality standards. Despite working remotely, you will often participate in virtual team meetings, case discussions, and ongoing training sessions to stay updated on protocols and best practices.

What is the difference between Full Time Remote Clinical Reviewer vs Part Time Remote Clinical Reviewer?

AspectFull Time Remote Clinical ReviewerPart Time Remote Clinical Reviewer
Work HoursTypically 40 hours/weekLess than 20 hours/week
CertificationsRequired clinical credentials (e.g., RN, LPN, or relevant license)Same as full-time, but flexible scheduling
Work EnvironmentRemote, home-basedRemote, home-based
Employer UsageCommon in healthcare and insurance companiesSimilar, often for supplemental or flexible roles

Full Time Remote Clinical Reviewers work standard hours and are employed full-time, focusing on comprehensive case reviews. Part Time Remote Clinical Reviewers have flexible schedules with fewer hours, often for supplemental work. Both roles require relevant clinical credentials and are performed remotely within healthcare and insurance industries.

What are popular job titles related to Full Time Remote Clinical Reviewer jobs in Raleigh, NC?

For Full Time Remote Clinical Reviewer jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Full Time Remote Clinical Reviewer jobs in Raleigh, NC look for?

The top searched job categories for Full Time Remote Clinical Reviewer jobs in Raleigh, NC are:

Full Time Remote Clinical Reviewer jobs near you
Infographic showing various Full Time Remote Clinical Reviewer job openings in Raleigh, NC as of August 2026, with employment types broken down into 3% As Needed, 72% Full Time, 17% Part Time, and 8% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $72,621 per year, or $34.9 per hour.

Clinical Quality Analyst (Full-time Remote, North Carolina Based)

Morrisville, NC • On-site, Remote

Alliance Health
See more jobs at Alliance Healthexternal

$79K - $101K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 19 days ago

Job description

The Clinical Quality Analyst manages the quality review process for care management programs. Incumbents conduct quality reviews of internal data and processes to identify trends/patterns that impact service/system quality and may require interventions.

This position is fulltime remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office may be required. 

Responsibilities & Duties

Analyze Care Management documentation and activities to ensure compliance

  • Review the quality-of-Care Management internal processes/plans and provider information, such as Person-Centered Plans or chart notes, for alignment with procedures and/or best practices
  • Audit Care Management clinical documentation, case interventions, and, if available, staff phone recordings to ensure alignment with program descriptions, workflows, internal policies, evidence based clinical guidelines, NCQA guidelines, CMS guidelines, and regulatory guidelines (when applicable)
  • Identify and escalate situations which may pose quality, compliance, and safety risks that may adversely affect business operation
  • Evaluate clinical appropriateness of decisions, recommendations, and actions within Care Management documentation 
  • Interpret qualitative and quantitative information to appropriately document findings
  • Make recommendations for improvement related to any records reviewed and write reports of findings
  • Identify system and/or operational issues hindering the attainment of quality performance standards as defined by NCQA standards, applicable state and Federal laws and regulations

Analyze Data and Report on findings

  • Generate monthly Care Management Quality reports on Staff performance to submit to Directors, Managers, and Supervisors 
  • Provide written feedback to Directors, Managers and Supervisors concerning quality concerns pertaining to individual performance, compliance risks/trends, root cause analysis and any system or process improvements recommended

Evaluate knowledge gaps of staff and coordinate training

  • Evaluate knowledge gaps of the staff and collaborate with Care Management Leadership to coordinate learning and training opportunities with the Care Management Training team 
  • Monitor training of staff for effectiveness and impact of outcomes from enhanced training

Minimum Requirements

Graduation from an accredited school of Nursing with a Registered Nurse (RN) license and three (3) years of experience providing care management to individuals in the following populations; Traumatic Brain Injuries (TBI), Intellectual/Developmental Disabilities (I/DD), Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), or Physical Health (PH)

Or

Master’s degree in Health, Psychology, Sociology, Social Work, or another relevant Human Services field from an accredited college/university with a North Carolina Clinical license (LCSW, LCMHC, LMFT, LPA) and three (3) years of experience providing care management to individuals in the following populations; Traumatic Brain Injuries (TBI), Intellectual/Developmental Disabilities (I/DD), Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), or Physical Health (PH)

Required experience

  • Experience with Care plans, comprehensive assessments, care management interventions, and service engagement activities
  • Medicaid Managed Care 
  • Integrated care (behavioral and physical health)

Preferred Experience

  • Auditing Clinical documentation 

Preferred Certification-

  • Certified Care Manager (CCM)

Special Requirement

Current, active, unrestricted NC clinical license such as RN, LCSW, LMHC, or LMFT to practice as a health professional within the scope of licensure in the state of North Carolina.

Knowledge, Skills, & Abilities

  • Knowledge of North Carolina State and Federal rules and requirements related to the service continuum in North Carolina
  • Knowledge of Tailored Plan, Integrated Care and Care Management processes and regulatory requirements
  • Knowledge of best and promising practices for behavioral & physical health and/or intellectual/developmental disabilities
  • Microsoft Excel, Word, PowerPoint, SPSS, and Survey Monkey (or other online survey tool)
  • Strong clinical skills
  • Problem solving skills
  • Interpersonal Skills
  • Strong Analytical skills
  • Problem solving and conflict resolution skills
  • Strong diplomacy skills and discretion
  • Highly effective communication skills
  • Ability to negotiate and resolve issues with minimal assistance

Salary Range

$79,425 - $101,267/ Annually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

An excellent fringe benefit package accompanies the salary, which includes:  

  • Medical, Dental, Vision, Life, Long Term Disability
  • Generous retirement savings plan
  • Flexible work schedules including hybrid/remote options
  • Paid time off including vacation, sick leave, holiday, management leave
  • Dress flexibility

Want to learn more about what it's like work as part of the Care Management Team? Click on our video to learn more: https://youtu.be/1GZOBFx61QU 

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