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Home Based Medical Necessity Reviewer Jobs (NOW HIRING)

Comagine

Clinical Reviewer RN - Alabama

... based in Alabama to assess the medical necessity and quality of healthcare services through ... Performing PA reviews * Long-term care including nursing home, ICF/IID, swing bed, PEC, and ...

Humana

Medical Director - Inpatient Review

Perform expert clinical review of inpatient medical records, assessing medical necessity based on ... To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided ...

CommonSpirit Health

Hospitalist Physician

Phoenix, AZ · On-site

$252K/yr

Job Summary and Responsibilities As our Physician Advisor, you will promote evidence-based medical ... Provide a more cost-effective delivery of secondary medical necessity reviews than what is ...

Fabergent

Clinical Care Reviewer

Doral, FL

... care home infusion services, outpatient and/or inpatient elective surgery, and referrals for ... Refers cases to KFHP Medical Director for medical necessity review when medical information ...

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How much do home based medical necessity reviewer jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for home based medical necessity reviewer in the United States is $42.06, according to ZipRecruiter salary data. Most workers in this role earn between $22.84 and $54.09 per hour, depending on experience, location, and employer.

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Contract Physician - Medical Necessity Review (Genetic Testing)

Everlywell

Remote

Contractor

Medical

Re-posted 5 days ago

Job description

Everlywell is a digital health company pioneering the next generation of biomarker intelligence-combining AI-powered technology with human insight to deliver personalized, actionable health answers. We transform complex biomarker data into life-changing insights-seamlessly integrating advanced diagnostics, virtual care, and patient engagement to reshape how and where health happens.
Over the past decade, Everlywell has delivered close to 1 billion personalized health insights, transforming care for 60 million people and powering hundreds of enterprise partners. In 2025, an estimated 1 in 94 U.S. adults received an Everlywell test, solidifying our spot as the #1 at-home testing company in the country. Fueled by AI and built for scale, we're breaking down barriers, closing care gaps, and unlocking a more connected healthcare experience that is smarter, faster, and more personalized.
PWN Remote Care Services, P.A. (PWN) is a telehealth practice facilitating access to high-quality, diagnostic-driven patient care. PWN is part of a provider network affiliated with Everlywell, a leading remote-based healthcare company. At PWN our mission is to enable access to diagnostic testing, treatment, and professional guidance that empowers individuals to improve their health. Our suite of services enables a broad spectrum of health industry clients to provide seamless access to diagnostic testing and related care interventions. We are a 50-state physician, registered nurse, and genetic counselor network with a strong care coordination and patient support team and technology infrastructure.
Our model integrates genetic counselors, physicians, and technology to ensure clinically appropriate and compliant genetic testing services. We are seeking physicians to support asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal payers. As such, strict adherence to documentation standards, medical necessity criteria, and applicable state and federal regulations is required.
Responsibilities
  • Review clinical documentation completed by a Genetic Counselor following patient history intake and pre-test counseling.
  • Assess and determine medical necessity for genetic testing.
  • Review and authorize testing orders & sign required supporting documents, when deemed appropriate.
  • Ensure compliance with state regulations, payer requirements, and internal clinical protocols.
  • Maintain HIPAA compliance and documentation standards.

Qualifications
  • Active, unrestricted medical license in good standing. License in Kansas or Arkansas (along with residence in KS or AR) prioritized.
  • Medicare enrollment required. Enrollment in Kansas or Arkansas Medicaid preferred, or willingness to enroll with administrative support.
  • Board Certified in primary care specialty (Internal Medicine, Family Medicine, Pediatrics, or other relevant specialty).
  • Ability to independently evaluate clinical documentation and render medical necessity determinations.
  • Comfortable working in a fully asynchronous, technology-enabled workflow.
  • Strong attention to detail and documentation accuracy.
  • Telehealth or virtual care experience preferred.

Ideal Experience
  • Prior experience with genetic testing
  • Familiarity with payer medical necessity criteria
  • Experience working with Medicaid populations

Benefits
  • Fixed payment per review
  • Flexible schedule
  • 100% Remote
  • Professional Liability Insurance

Security Notice: Everlywell never requests fees, payment, or banking information at any stage of the recruitment process. Official communications and interview invitations will only come from verified email addresses ending in @everlywell.com or @everlyhealth.com. To ensure your application is secure, always apply directly through our official careers page at https://www.everlywell.com/careers/.
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

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