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Medical Case Reviewer information

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$15

$27

$50

How much do medical case reviewer jobs pay per hour?

As of Jun 30, 2026, the average hourly pay for medical case reviewer in the United States is $27.89, according to ZipRecruiter salary data. Most workers in this role earn between $21.15 and $31.25 per hour, depending on experience, location, and employer.

What are some common challenges faced by Medical Case Reviewers in balancing accuracy with productivity?

Medical Case Reviewers often navigate the challenge of thoroughly evaluating complex clinical documentation while meeting productivity targets. Balancing the need for precise, evidence-based assessments with efficiency requires strong organizational skills and up-to-date knowledge of medical guidelines. Additionally, reviewers may encounter incomplete or ambiguous information, necessitating effective communication with healthcare providers to clarify details. Adapting to varying case types and regulatory requirements also adds complexity, making adaptability and continuous learning essential for success.

What is the difference between Medical Case Reviewer vs Medical Claims Adjuster?

AspectMedical Case ReviewerMedical Claims Adjuster
Required CredentialsMedical degree or nursing license, certifications in case reviewInsurance licensing, sometimes medical background
Work EnvironmentHealthcare facilities, insurance companies, remoteInsurance companies, claims departments, remote
Industry UsageHealthcare, insurance, legalInsurance, healthcare
Common Search/ComparisonYesYes

Medical Case Reviewers evaluate medical records to determine coverage and treatment necessity, often requiring medical credentials. Medical Claims Adjusters handle insurance claims, assessing damages and coverage, sometimes with medical knowledge. While both roles involve insurance and healthcare, Medical Case Reviewers focus on clinical review, whereas Claims Adjusters focus on claims processing and settlement.

What are Medical Case Reviewers?

Medical Case Reviewers are healthcare professionals who assess and evaluate medical records, cases, or claims to ensure they meet regulatory, clinical, and organizational standards. They analyze documentation for completeness, accuracy, and compliance with policies and guidelines. Their work is crucial in healthcare settings, insurance companies, or clinical research organizations to support quality assurance and proper adjudication of medical cases. Medical Case Reviewers often have backgrounds in nursing, medicine, or related health fields, and they play a key role in maintaining the integrity of patient care and data.

What are the key skills and qualifications needed to thrive as a Medical Case Reviewer, and why are they important?

To thrive as a Medical Case Reviewer, you need a solid background in healthcare or life sciences, often supported by a clinical degree and experience in medical record analysis. Familiarity with case management software, regulatory guidelines, and electronic health records (EHRs) is typically required. Attention to detail, critical thinking, and strong written communication are essential soft skills for evaluating cases and preparing comprehensive reports. These competencies are crucial for ensuring accurate case assessments, maintaining compliance, and supporting patient safety.
More about Medical Case Reviewer jobs
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What states have the most Medical Case Reviewer jobs? States with the most job openings for Medical Case Reviewer jobs include:
Medical Case Reviewer jobs near you

COMPLEX MEDICAL CASE REVIEWER

New York City | Jobs

Manhattan, NY • On-site

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Complex Medical Case Reviewer

The Department of Social Services (DSS) is comprised of the administrative units of the New York City Human Resources Administration (HRA) and the Department of Homeless Services (DHS). HRA is dedicated to fighting poverty and income inequality by providing New Yorkers in need with essential benefits such as Food Assistance and Emergency Rental Assistance. DHS is committed to preventing and addressing homelessness in New York City by employing a variety of innovative strategies to help families and individuals successfully exit shelter and return to self-sufficiency as quickly as possible. The DSS Accountability Office (DSS-AO) is responsible for protecting the integrity of social services programs administered by the New York City Department of Social Services (DSS) and ensuring that DSS complies with all statutory, regulatory, and contractual standards. The Office of Revenue comprises divisions and offices performing revenue collections and centralized data reporting. The Division of Liens and Recovery Casualty Program places liens and assert claims against the personal injury lawsuit settlements of past or present recipients of Medicaid and Cash Assistance pursuant to NYS SSL 104 and 104-b. At the time of a lawsuit settlement, law firms and insurance companies must contact the Division to obtain a final lien amount. Total settlement amount from all defendants is needed to discuss lien re-payment. Office of Liens and Trusts (OLT) is recruiting for (1) one Supervisor of Nurses I to function as a Complex Medical Case Reviewer, who will:

  • Conduct medical reviews and analyses claims to calculate injury related Medicaid liens pursuant to SSL-104b on cases involving medical malpractice, mass medical torts, lead paint poisoning, traumatic brain injury, or other catastrophic or medically complex cases.
  • Consult Medicaid payment records, bills of particulars, and other legal or medical documents provided. Update database system with notes and other records to support calculations.
  • Draft appropriate correspondence including statements of aid paid, notice of lien letter, affidavits and lien agreement letters. Fax and/or mail correspondence to plaintiff attorneys, defense attorneys, and/or clients. When appropriate submit affidavit to court supporting lien calculations and conclusions.
  • Communicate with plaintiff's counsel to obtain additional medical documentation or information. Negotiate repayment of the Medicaid lien with counsel.
  • Testify in Court to defend and support the Department of Social Services' lien.

Hours/Shift: 9AM -5PM SUPERVISOR OF NURSES - 50960

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