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Medical Case Reviewer Jobs (NOW HIRING)

Crawford and Company

Medical Case Manager

Wayne, NJ · On-site

$52K - $96K/yr

Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by ...

Empath Health

Medical Case Manager

Clearwater, FL · On-site

The Medical Case Manager may manage as many as 75 clients, per State of Florida Department of ... For further information, please review the Know Your Rights notice from the Department of Labor.

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Medical Case Reviewer information

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How much do medical case reviewer jobs pay per hour?

As of Jun 10, 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
What cities are hiring for Medical Case Reviewer jobs? Cities with the most Medical Case Reviewer job openings:
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
Infographic showing various Medical Case Reviewer job openings in the United States as of June 2026, with employment types broken down into 83% Full Time, and 17% Part Time. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $58,003 per year, or $27.9 per hour.
Medical Case Manager

Medical Case Manager

Crawford and Company

Peachtree Corners, GA • On-site, Remote

$52K - $96K/yr

Full-time

Posted 13 days ago

Job description

Job Description
Now Hiring: RN Case Manager - Oklahoma City, OK Region
Work from home + local field travel
Salary: Competitive & commensurate with experience
Quarterly Bonus Opportunities
Free CEUs for licenses & certificates
License & Certification Reimbursement
We're looking for an RN with a passion for case management to join our team!
RN degree required
National Certification preferred (CCM, CRC, COHN, CRRC)
Workers' Comp Case Management experience a plus
Location Requirement
Candidates must be based in Oklahoma City or cities along the corridor up to Tulsa (including Edmond, Norman, Moore, Stillwater, and surrounding areas)
✅ Your Impact: You'll provide effective case management services in a cost-effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management.
This is your chance to grow your career, earn great rewards, and enjoy true work-life balance.
Apply today and make an impact in the Oklahoma City community!
Responsibilities
  • Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services.
  • Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW.
  • Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention.
  • May perform job site evaluations/summaries to facilitate case management process.
  • Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians.
  • Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual.
  • May obtain records from the branch claims office.
  • May review files for claims adjusters and supervisors for appropriate referral for case management services.
  • May meet with employers to review active files.
  • Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians.
  • Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly.
  • May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases.
  • Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product.
  • Reviews cases with supervisor monthly to evaluate files and obtain directions.
  • Upholds the Crawford and Company Code of Business Conduct at all times.
  • Demonstrates excellent customer service, and respect for customers, co-workers, and management.
  • Independently approaches problem solving by appropriate use of research and resources.
  • May perform other related duties as assigned.

Qualifications
  • Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred.
  • Minimum of 1-3 years diverse clinical experience and one of the below:
  • Certification as a case manager from the URAC-approved list of certifications (preferred);
  • A registered nurse (RN) license.
  • Must be compliant with state requirements regarding national certifications.
  • General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services.
  • Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation.
  • Excellent analytical and customer service skills to facilitate the resolution of case management problems.
  • Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes.
  • Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees.
  • Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes.
  • Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously.
  • Demonstrated leadership ability with a basic understanding of supervisory and management principles.
  • Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19.
  • Active RN home state licensure in good standing without restrictions with the State Board of Nursing.
  • Must meet specific requirements to provide medical case management services.
  • Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months.
  • National certification must be obtained in order to reach Senior Medical Case Management status.
  • Travel may entail approximately 70% of work time.
  • Must maintain a valid driver's license in state of residence.

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About Us
Why Crawford?
Because a claim is more than a number - it's a person, a child, a friend. It's anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community - one claim at a time.
At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We're looking for the next generation of leaders to take this journey with us.
We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com.
When you accept a job with Crawford, you become a part of the One Crawford family.
Our total compensation plans provide each of our employees with far more than just a great salary
  • Pay and incentive plans that recognize performance excellence
  • Benefit programs that empower financial, physical, and mental wellness
  • Training programs that promote continuous learning and career progression while enhancing job performance
  • Sustainability programs that give back to the communities in which we live and work
  • A culture of respect, collaboration, entrepreneurial spirit and inclusion
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.

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