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 ...
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 ...
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 ...
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 ...
MSO PHYSICIAN REVIEWER
Burlingame, CA · On-site
This role involves conducting evidence-based medical necessity reviews for inpatient and outpatient services, assessing prior authorization requests, and supporting appeals and grievance processes.
MSO PHYSICIAN REVIEWER
Burlingame, CA · On-site
This role involves conducting evidence-based medical necessity reviews for inpatient and outpatient services, assessing prior authorization requests, and supporting appeals and grievance processes.
MSO PHYSICIAN REVIEWER
Burlingame, CA · On-site
$285K - $332K/yr
This role involves conducting evidence-based medical necessity reviews for inpatient and outpatient services, assessing prior authorization requests, and supporting appeals and grievance processes.
MSO PHYSICIAN REVIEWER
Burlingame, CA · On-site
$285K - $332K/yr
This role involves conducting evidence-based medical necessity reviews for inpatient and outpatient services, assessing prior authorization requests, and supporting appeals and grievance processes.
This role involves conducting evidence-based medical necessity reviews for inpatient and outpatient services, assessing prior authorization requests, and supporting appeals and grievance processes.
This role involves conducting evidence-based medical necessity reviews for inpatient and outpatient services, assessing prior authorization requests, and supporting appeals and grievance processes.
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. * Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. * Using clinical knowledge and nursing experience, the nurse reviews ...
Clinical Care Reviewer
Des Moines, IA · On-site
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Clinical Care Reviewer
Des Moines, IA · On-site
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Clinical Care Reviewer
Des Moines, IA · On-site
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Clinical Care Reviewer
Des Moines, IA · On-site
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Conducts initial medical necessity clinical screening for simple and routine review cases. * Determines if initial clinical information presented meets medical necessity criteria or requires ...
Medical Necessity Reviewer information
See salary details
$11.78 - $19.84
14% of jobs
$24.28 is the 25th percentile. Wages below this are outliers.
$19.84 - $27.91
21% of jobs
The median wage is $32.08 / hr.
$27.91 - $35.97
30% of jobs
$35.97 - $44.03
9% of jobs
$46.72 is the 75th percentile. Wages above this are outliers.
$44.03 - $52.10
3% of jobs
$52.10 - $60.16
13% of jobs
$60.16 - $68.23
1% of jobs
$68.23 - $76.29
4% of jobs
$76.29 - $84.35
0% of jobs
$84.35 - $92.42
0% of jobs
$92.42 - $100.48
5% of jobs
$11
$42
$100
How much do medical necessity reviewer jobs pay per hour?
As of Sep 12, 2026, the average hourly pay for 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.
What is a medical necessity reviewer?
A Medical Necessity Reviewer evaluates healthcare services, treatments, and procedures to determine if they meet medical necessity criteria based on established guidelines and insurance policies. They review patient records, consult clinical guidelines, and ensure compliance with regulatory standards. Their role helps control healthcare costs while ensuring patients receive appropriate care. Typically, they work for insurance companies, healthcare organizations, or government agencies. Strong clinical knowledge and attention to detail are essential for this role.
What are the primary responsibilities and daily tasks of a medical necessity reviewer?
As a Medical Necessity Reviewer, your primary responsibilities include reviewing clinical documentation to determine if requested medical services meet established criteria for necessity and coverage. On a typical day, you may analyze patient charts, collaborate with physicians for clarification, and communicate review outcomes to both healthcare providers and insurance payers. You'll also document your findings in compliance with policies and regulatory standards, often using utilization management platforms. In addition, you may participate in team meetings or case discussions to resolve complex cases and stay updated on changing guidelines. This role requires a balance of independent review work and teamwork to ensure the best possible patient outcomes and compliance with payer requirements.
What are the key skills and qualifications needed to thrive as a medical necessity reviewer?
To thrive as a Medical Necessity Reviewer, you need a strong knowledge of clinical guidelines, insurance policies, and medical coding, usually supported by a background in nursing or a related healthcare field. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as Certified Professional in Healthcare Quality (CPHQ) are commonly required. Strong attention to detail, effective communication, and critical thinking are valuable soft skills for success in this role. These skills are essential to accurately assess the medical necessity of procedures, ensure compliance, and facilitate clear documentation and collaboration with providers.
More about Medical Necessity Reviewer jobs
What cities are hiring for Medical Necessity Reviewer jobs?
Cities with the most Medical Necessity Reviewer job openings:
What are the most commonly searched types of Medical Necessity Reviewer jobs?
The most popular types of Medical Necessity Reviewer jobs are:
What states have the most Medical Necessity Reviewer jobs?
States with the most job openings for Medical Necessity Reviewer jobs include:
What are popular job titles related to Medical Necessity Reviewer jobs?
For Medical Necessity Reviewer jobs, the most frequently searched job titles are:
Contract Physician - Medical Necessity Review (Genetic Testing)
Remote
EverlyWell
• 51 - 200 employees51 - 200 employees
Other
Medical
Re-posted 16 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.
- 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.
- Prior experience with genetic testing
- Familiarity with payer medical necessity criteria
- Experience working with Medicaid populations
- 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.
About Everlywell
Sourced by ZipRecruiter
Company size
51 - 200 Employees
Headquarters location
Austin, TX, US
Year founded
2015