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Medical Case Reviewer Jobs (NOW HIRING)

Crawford and Company

Medical Case Manager

Phoenix, AZ · On-site

$53K - $98K/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.

Addison Group

Medical Case Coordinator

Schertz, TX · On-site

$18 - $23/hr

Medical Case Coordinator Location: Schertz, TX (Onsite) Job Type: Contract-to-hire Pay: $18.00 ... Review documents for accuracy, formatting, and adherence to internal standards * Ensure compliance ...

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Medical Case Reviewer information

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How much do medical case reviewer jobs pay per hour?

As of Jul 24, 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.

How to become a medical record reviewer?

To become a medical record reviewer, candidates typically need a background in healthcare, such as a registered nurse, medical coder, or healthcare administrator. Relevant skills include knowledge of medical terminology, coding systems, and familiarity with electronic health records; obtaining certifications like Certified Professional Medical Auditor (CPMA) can also enhance job prospects.

How can I make 2000 a week working from home?

A Medical Case Reviewer can potentially earn $2,000 a week by working full-time hours, often requiring strong attention to detail, medical knowledge, and familiarity with electronic health records. Increasing income may involve taking on multiple cases, working overtime, or gaining specialized certifications to qualify for higher-paying assignments. Flexibility and efficiency in reviewing cases are key to reaching this income level from home.

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 does a medical reviewer do?

A medical reviewer evaluates medical records, claims, and documentation to determine the accuracy, completeness, and compliance with healthcare policies and regulations. They often work for insurance companies, healthcare organizations, or government agencies, using clinical knowledge and review tools to make informed decisions about patient care, claims approval, or policy adherence.

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.

What jobs pay 4000 a week without a degree?

Medical Case Reviewers typically do not earn $4,000 a week without specialized experience or certifications. High-paying roles that can reach this level without a degree often include skilled trades like commercial pilots, real estate brokers, or sales managers, which may require licenses or extensive experience. Most jobs paying this amount without a degree involve specialized skills, certifications, or significant experience in the field.
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 July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 17% Part Time, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $58,003 per year, or $27.9 per hour.
Lead Medical Case Manager

Lead Medical Case Manager

Positive Impact Health Centers INC

Duluth, GA • On-site

$65K/yr

Full-time

Medical, Retirement

Posted 20 days ago

Job description

Job Type
Full-time
Description
Are you seeking a career with a growing company, a place where you can make an impact in the community? Then Positive Impact Health Centers is the company for you.
What makes us different? We offer our employees the following:
• 1 Health Wellness day per quarter
• Parental Leave
• Free parking at our locations/bus line accessibility
• Competitive Salary & Benefits
• Automatic 3% Safe Harbor & 2% Profit Sharing (Retirement Program)
• 100% allotted for benefit elections for employees, 50% allotted for benefit elections for employees' spouse/dependents
• Credit Union
JOB SUMMARY: The Lead Medical Case Manager (LMCM) will provide medical case management services to eligible adult clinic patients at Positive Impact Health Centers, following applicable funding guidelines and best practice care models, as well as oversee the supervision of Medical Case Managers within their assigned care team at their designated PIHC Center. The LMCM will function as an integral member of an interdisciplinary team which may include the following: medical provider, behavioral health clinician, medication access specialist, clinical pharmacist, and supportive services staff (Community Health Worker, Patient Navigator, Retention/Adherence Manager). This position description should not be interpreted as all-inclusive. It is intended to identify the major responsibilities and requirements of this position. The incumbent may be requested to perform job-related responsibilities and tasks other than those stated in this position description.
This position description should not be interpreted as all-inclusive. It is intended to identify the major responsibilities and requirements of this position. The incumbent may be requested to perform job-related responsibilities and tasks other than those stated in this position description.
Requirements
JOB DUTIES & RESPONSIBILITIES
Essential Duties, Tasks, and Responsibilities:
  • Learn and remain current on practice issues related to HIV/AIDS, related medical diagnoses, and medical case management.
  • Provide medical case management services to identified patients of the clinic program, following medical case management guidelines established by HRSA/Ryan White and the Metropolitan Atlanta HIV Health Services Planning Council.
  • Provide instruction and supervision to assigned staff regarding Federal, State, health district, and agency standards, procedures and policies.
  • Ensure that assigned staff are performing day-to-day operations, including but not limited to the coverage of the departmental Resource Line and the scheduling of patient enrollment visits.
  • Provide medical case management services to an average caseload size of 40 patients: develop a comprehensive Individualized Service Plan (ISP);
  • Assign clinic patients to Medical Case Managers (MCM) for medical and non-medical services, utilizing Acuity Level scores and service needs while also maintaining equitable caseload sizes for MCM staff.
  • Participate in weekly interdisciplinary Case Conference meetings, leading the meeting as needed.
  • Participate in daily huddles with assigned care team, and assist with documentation of summary.
  • Assist with monitoring and responding to dedicated resource line.
  • Collaborate with Site Coordinator and Data Team to collect data and review reports for assigned care team to measure patient acuity and health care outcomes, and staff productivity.
  • Assist with the orientation of new medical case managers at the designated PIHC Center.
  • Assist and consult with interdisciplinary care team regarding patients' ongoing need for care and referrals.
  • Assist Site Coordinator with managing the EMR Medical Case Management pool and assign clients to medical case manager accordingly.
  • Document patient information, activities, referrals and consultations in a timely and accurate manner, through the use of the agency's electronic medical record system and related reporting software.
  • Abide by all state, federal laws and agency policies as related to confidentiality and Health Insurance Portability and Accountability Act (HIPAA).
  • Organize and lead weekly team meetings.
  • Monitor time and attendance of assigned staff in agency's electronic payroll system.
  • Complete performance evaluations with assigned staff.
  • Abides by all agency policies and procedures, including conflict of interest policy.
  • Additional duties as assigned.

Summary of General Duties, Tasks, and Responsibilities:
• Provide medical case management services to patients living with HIV, for up to a caseload size of 40, as determined by Ryan White/HRSA guidelines
• Supervise assigned Medical Case Managers and ensure they are performing day-to-day operations and tasks, this includes one-on-one ongoing supervision
• Collaborate with patient to develop, monitor and update the Individualized Service Plan (ISP)
• Collaborate with interdisciplinary care team to address patient barriers, develop necessary interventions and evaluate treatment outcomes
• Consult and collaborate with Site Coordinator with care team tasks and goals.
• Attend patient huddles and case conferences
• Ensure patients have access to medication and/or HIV medical care
• Complete and update Acuity Scale, along with EMA Screening Tool, as needed
• Document all patient interactions in the EMR
• Assist patients with social service needs, in-person and/or through resource line
• Coordinate provision of services and referrals for patients
• Complete patient reassessments as needed
• Assist with screening, completing and coordinating initial enrollments for rapid entry patients and transfer patients entering HIV medical care at PIHC
• Abide by all state, federal laws and agency policies as related to confidentiality and Health Insurance Portability and Accountability Act (HIPAA).
• Assist the agency administration in the development of long-range plans, including goals and objectives, as directed by supervisor.
• Abides by all agency policies and procedures, including conflict of interest policy.
• Additional duties as assigned.
MINIMUM QUALIFICATIONS & EXPERIENCE:
• Master in Social Work (or related social services degree) with at least 2-year experience providing medical case management or medical social work OR Bachelor in Social Work (or bachelor's degree in a related social services field) with a
minimum of 5-year experience supervising social services providers.
• Fluency (written and verbal) in Spanish strongly preferred, but not required.
• Administrative or supervisory experience required.
• Minimum of 2-year experience in a service delivery setting, with an emphasis on locating, coordinating and developing supportive services for identified clients across a broad psychosocial continuum is required.
• Must have minimum 1-year experience in an HIV care setting.
• Previous professional experience with Electronic Medical Record (EMR) system documentation preferred
PREFERRED KNOWLEDGE, SKILLS, ABILITIES & OTHER APTITUDES (KSAOs):
Knowledge, Skills, Abilities, and Other Aptitudes (KSAOs):
  • Must possess the ability to handle conflict and crisis in a professional manner.
  • Excellent verbal and written communication skills.
  • Requires advanced computer knowledge, especially MS Office, with the ability to learn many different computer software packages.
  • Must have excellent interpersonal skills.
  • Must have demonstrated leadership and management skills.
  • The ability to prioritize tasks and manage time efficiently.
  • The ability to be flexible as to the changing needs of the Center.
  • Ability to work in a multidisciplinary team

PHYSICAL DEMANDS:
  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • While performing the duties of this job, the employee is frequently required to sit and talk or hear. The employee is occasionally required to walk, use hands to finger, handle, or operate computers, objects, tools, or controls and reach with hands and arms.
  • The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

NOTES:
  1. Positive Impact Health Centers, Inc., is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, or covered veteran status.
  2. Recreational drugs, weapons and violence are not permitted on agency property or at any agency events or programs.
  3. The above job description represents the general nature, primary duties and responsibilities, and qualifications for the work performed by employees within this job, but is not a comprehensive and exhaustive list. Employees may be required to perform other duties as assigned, and specific duties, responsibilities, and activities within the core nature of the job may change at any time with or without notice. Employees must be able to perform the essential functions of the job, as specified by the employing entity, with or without reasonable accommodation.

Salary Description
$65,000

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