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Medical Review Jobs (NOW HIRING)

Empower AI

Medical Reviewer III (Medicare/DME)

$28.38/hr

Medical Review Specialist III Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston ...

RXinsider LTD.

Reviews and interprets drug test results, including determining legitimate medical explanations in accordance with federal regulations. * Ensures compliance with specimen collection procedures, chain ...

MMRO

Oncology- Independent Medical Reviewer

Managed Medical Review Organization (MMRO) Employment Type: Independent Contractor Industry: Healthcare About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited ...

State of North Carolina

NC · On-site

$62K - $102K/yr

The primary purpose of this position is to review medical records, statements from medical providers, and driving records to make determinations regarding the status of a citizen's driving privileges.

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is a nationally recognized, URAC-accredited Independent Review Organization (IRO) specializing in objective, evidence-based medical peer reviews ...

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Medical Review information

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$36.5K

$164.7K

$337K

How much do medical review jobs pay per year?

As of Sep 11, 2026, the average yearly pay for medical review in the United States is $164,731.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,000.00 and $268,500.00 per year, depending on experience, location, and employer.

What is medical review?

Medical review refers to the process of evaluating medical information, records, or claims to ensure accuracy, compliance, and appropriateness based on clinical guidelines and policies. Professionals in medical review often assess documentation for insurance claims, pre-authorization requests, or clinical trials. Their work helps ensure that patients receive appropriate care and that healthcare providers follow industry standards.

What are the key skills and qualifications needed to thrive as a medical reviewer?

To thrive as a Medical Reviewer, you need a strong understanding of clinical medicine, scientific research, and regulatory guidelines, often supported by a medical degree or advanced healthcare qualification. Familiarity with medical databases, regulatory submission systems, and tools like MedDRA coding or CTD formatting is typically required. Attention to detail, analytical thinking, and effective written communication are essential soft skills for reviewing complex documents and collaborating with multidisciplinary teams. These skills ensure accurate, compliant, and high-quality medical evaluations that support regulatory approvals and patient safety.

How does a medical review professional typically collaborate with other departments within a healthcare or insurance organization?

Medical Review professionals frequently work closely with clinical staff, claims adjusters, and compliance teams to ensure that medical records and claims are accurately assessed and meet regulatory standards. Collaboration often involves discussing complex cases, clarifying clinical documentation, and providing guidance on policy interpretation. Effective communication and teamwork are essential, as Medical Review staff often act as a bridge between medical and administrative teams to support fair and thorough claims processing.

What is the difference between Medical Review vs Medical Coding Specialist?

AspectMedical ReviewMedical Coding Specialist
Required CredentialsMedical degree or clinical background, certifications like CCM or CRCCertification in coding (CPC, CCS), knowledge of coding systems
Work EnvironmentHealthcare facilities, insurance companies, telehealthHospitals, clinics, insurance companies, remote coding
Employer & Industry UsageUsed to assess medical necessity, compliance, and documentationUsed to assign billing codes based on medical records

Medical Review involves evaluating medical records for accuracy, compliance, and appropriateness, often requiring clinical expertise. Medical Coding Specialists focus on translating medical documentation into standardized codes for billing and insurance purposes. While both roles require healthcare knowledge, Medical Review emphasizes clinical assessment, whereas Medical Coding centers on coding accuracy for reimbursement.

How do you become a medical reviewer?

To become a medical reviewer, typically one needs a medical degree such as an MD or DO, along with clinical experience in a relevant specialty. Additional qualifications may include familiarity with medical guidelines, strong analytical skills, and sometimes certification in medical review or coding; some roles also require knowledge of healthcare regulations and documentation standards.

How much do medical reviewers make in the US?

Medical reviewers in the US typically earn between $60,000 and $90,000 annually, depending on experience, location, and employer. Many roles require medical credentials and familiarity with healthcare regulations, with some positions offering additional benefits or bonuses.
More about Medical Review jobs

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Cities with the most Medical Review job openings:

What are the most commonly searched types of Medical Review jobs?

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For Medical Review jobs, the most frequently searched job titles are:

Medical Review jobs near you
Infographic showing various Medical Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, and 6% Contract. Highlights an 87% Physical, 1% Hybrid, and 12% Remote job distribution, with an average salary of $164,731 per year, or $79.2 per hour.

Medical Reviewer III (Medicare/DME)

Remote

Empower AI
IT Services • 1 - 5K employees
Learn more about Empower AIexternal

$28.38/hr

Other

Re-posted 12 days ago

Job description

Medical Review Specialist III

Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. The result is a government workforce that is exponentially more creative and productive.

Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs. This designation reflects the company's commitment to hiring and supporting active-duty and veteran employees.

As a Medical Review Specialist III for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment. Perform projects or duties as assigned as a Medical Review Specialist. You will serve as a critical component in meeting our mission of providing excellent services to our clients. In assuming this position, you will be a critical contributor to meeting Empower AI's mission: To deliver innovative, cost-effective solutions and services that enable our customers to rapidly adapt to dynamic environments.

Highlights of Responsibilities:

  • Perform comprehensive medical record and claims review to make payment determinations based on insurance coverage, coding, and utilization of services and practice guidelines for Medicare DME.
  • Performs first and second level of Medical Review in determination of claims payment review
  • Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles
  • Utilize electronic health information imaging and input medical review decisions by electronic database module.
  • Utilize internet and intranet sources for policy verification.
  • Utilize Microsoft Office suite and other software templates as associated source input for claims review.
  • Make clinical judgment decisions based on clinical experience when applicable.
  • Responsible for review of Medicare DME claims.
  • Meeting quality and production standards.
  • Ensuring departmental compliance with quality management system and ISO requirements.
  • Completes other projects or duties as assigned by the Medical Review Lead Specialist

Requirements:

  • Must be a Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing. At least four (4) years claims knowledge either from billing, reviewing, or processing of Durable Medical Equipment.
  • At least three (3) years clinical experience as a Registered Nurse.
  • Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and Ambulance Services.
  • Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
  • Ability to keep sensitive and confidential material private.
  • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).

Preferred Education and Experience:

  • Physician Office, Hospital, Supplier, or Clinic providing DME equipment care/services
  • Prior work as a Medicare Contractor Medical Review Nurse or Commercial Insurance for DME
  • Optional - Bilingual (Spanish) - Fluency in reading and understanding Spanish language especially as it relates to medical records is a plus!

Physical Requirements:

  • Sitting for long periods
  • Standing for long periods

About Empower AI:

All hiring and promotion decisions at Empower AI are based on merit to bring the best talent available to contribute to our firm's overall success. It is the policy of Empower AI not to discriminate against any applicant for employment, or employee because of age, color, sex, disability, national origin, race, religion, or veteran status. Empower AI is a VEVRAA Federal Contractor.

If hired for this position, the base salary range would be within the range provided. The base salary range represents the anticipated low and high end of the salary range for this position. Actual salaries may vary based on various factors including but not limited to work location, skills, experience, gov con contractual requirements, and performance. The range listed is just one component of Empower AI's total compensation package for employees.

Pay Band Min: USD $28.38/Hr.

Pay Band Max: USD $43.94/Hr.

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