Dallas, TX · Remote
$115K - $135K/yr
As an initial reviewer, you conduct initial clinical review and issue a recommendation for certification; however, as an initial reviewer, you never issue a non-certification determination (our ...
Dallas, TX · Remote
$115K - $135K/yr
As an initial reviewer, you conduct initial clinical review and issue a recommendation for certification; however, as an initial reviewer, you never issue a non-certification determination (our ...
Completes first level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review. General Medical-Surgical nursing is sufficient to be relevant to ...
Completes first level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review. General Medical-Surgical nursing is sufficient to be relevant to ...
Rockford, IL · On-site
$57K - $62K/yr
Completes first level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review. General Medical-Surgical nursing is sufficient to be relevant to ...
Rockford, IL · On-site
$57K - $62K/yr
Completes first level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review. General Medical-Surgical nursing is sufficient to be relevant to ...
Boston, MA · Remote
$248K - $373K/yr
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical ...
Boston, MA · Remote
$248K - $373K/yr
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical ...
Boston, MA · On-site +1
$248K - $373K/yr
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical ...
Boston, MA · On-site +1
$248K - $373K/yr
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical ...
Virginia Beach, VA · On-site
With a culture driven by purpose, straightforward communication and clinical domain expertise ... Conduct an initial assessment of documentation from both the initiating and responding parties.
Virginia Beach, VA · On-site
With a culture driven by purpose, straightforward communication and clinical domain expertise ... Conduct an initial assessment of documentation from both the initiating and responding parties.
Traverse City, MI · On-site
$71K - $81K/yr
... initial clinical assessments. Service location could be inconclusive in the community, ED's and ... Participate actively in Utilization Review, other Quality Assurance programs, in periodic ...
Traverse City, MI · On-site
$71K - $81K/yr
... initial clinical assessments. Service location could be inconclusive in the community, ED's and ... Participate actively in Utilization Review, other Quality Assurance programs, in periodic ...
$71K - $81K/yr
... initial clinical assessments. Service location could be inconclusive in the community, ED's and ... Participate actively in Utilization Review, other Quality Assurance programs, in periodic ...
$71K - $81K/yr
... initial clinical assessments. Service location could be inconclusive in the community, ED's and ... Participate actively in Utilization Review, other Quality Assurance programs, in periodic ...
Denver, CO · On-site
$95 - $100/hr
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Denver, CO · On-site
$95 - $100/hr
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
$95 - $100/hr
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
New
$95 - $100/hr
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
New
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Santa Fe, NM · On-site
$95 - $100/hr
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Santa Fe, NM · On-site
$95 - $100/hr
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
New
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
New
$95 - $100/hr
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
$95 - $100/hr
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
$24.28 - $26.29
6% of jobs
$26.29 - $28.30
7% of jobs
$28.30 - $30.31
5% of jobs
$31.47 is the 25th percentile. Wages below this are outliers.
$30.31 - $32.32
11% of jobs
$32.32 - $34.33
11% of jobs
The median wage is $35.04 / hr.
$34.33 - $36.34
28% of jobs
$36.34 - $38.35
3% of jobs
$39.44 is the 75th percentile. Wages above this are outliers.
$38.35 - $40.36
6% of jobs
$40.36 - $42.37
13% of jobs
$42.37 - $44.38
6% of jobs
$44.38 - $46.39
3% of jobs
$24
$35
$46
| Aspect | Initial Clinical Reviewer | Claims Reviewer |
|---|---|---|
| Required Credentials | Healthcare license, clinical experience, certifications (e.g., RN, LPN) | Insurance knowledge, certification in claims processing (e.g., CPC) |
| Work Environment | Hospitals, clinics, healthcare organizations | Insurance companies, third-party administrators |
| Employer & Industry Usage | Healthcare providers, managed care | Insurance carriers, claims processing firms |
| Common Search & Comparison Intent | Understanding clinical review roles in healthcare | Understanding claims processing and review roles |
The main difference is that Initial Clinical Reviewers focus on evaluating patient care and medical necessity based on clinical standards, while Claims Reviewers primarily assess insurance claims for accuracy and compliance. Both roles require industry-specific certifications and work within healthcare or insurance environments, but their core responsibilities differ significantly.
$115K - $135K/yr
Other
Posted 9 days ago
NantHealth is adding an Oncology Certified Nurse Practitioner (NP)to our Eviti clinical team. In this role, you'll assist the medical operations team with the application of oncology-specific medical expertise to complete customized treatment plan reviews as well as clinical trial reviews in our Eviti web based application. You'll partner with the Clinical Support and Case Review Nurses and the Medical Directors to insure that customized treatment plan reviews and clinical trials are accurately reviewed based on published literature and evidenced based guidelines. Time is of the essence in this role; you're responsible to ensure that customized treatment plans and clinical trials submitted to Eviti are reviewed in 72 hours or per client instruction. As an initial reviewer, you conduct initial clinical review and issue a recommendation for certification; however, as an initial reviewer, you never issue a non-certification determination (our physicians are responsible for this aspect). You'll partner with one of our qualified physician reviewer during standard operating hours to assist in initial clinical review.
This position offers the opportunity to work remotely within the United States and is for our scheduled shift of: 12:00 PM–8:30 PM Eastern /9:00 AM–5:30 PM Pacific
Responsibilities include, but are not limited to:
Required Certifications or License
Current Active Unrestricted Registered Licensure as a Nurse Practitioner in a state or territory of the United States
Education & Experience Requirements:
Required Knowledge Skills and Abilities:
The salary range for applicable US-based applicants to this position is below. The specific rate will depend on the successful candidate’s qualifications, prior experience as well as geographic location.
