Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Kansas, OK · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Kansas, OK · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Oregon, IL · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Oregon, IL · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Nevada, IA · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Nevada, IA · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Ohio, IL · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Ohio, IL · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Nevada, IA · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical Reviewer II (Prior-Auth A/B MAC) - CGS
Nevada, IA · On-site +1
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need ...
Medical 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 reviewer jobs pay per hour?
As of Jun 10, 2026, the average hourly pay for medical 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.
How does a Medical Reviewer typically collaborate with other departments during the drug approval process?
Medical Reviewers work closely with cross-functional teams, including clinical research, regulatory affairs, pharmacovigilance, and biostatistics. They review clinical trial data, ensure documentation complies with regulatory standards, and provide medical expertise during regulatory submissions. Effective communication is essential, as Medical Reviewers often participate in multidisciplinary meetings to address queries and ensure consistency in data interpretation throughout the approval process.
What Does a Medical Reviewer Do?
As a medical reviewer, your primary responsibilities are to review medical records to ensure accuracy. You address any issues or errors that you find with your supervisor’s assistance and contact medical providers to update information about patients. You may also audit medical files to determine whether the medical provider’s documentation complies with all federal and state regulations that affect accreditation, or if the facility qualifies for specific federal funding or participation in programs like Medicare. Medical reviewers most commonly work for an internal department at a hospital, medical care facility, or an outside organization, such as an insurance company or government agency.
What is a medical reviewer?
A medical reviewer is a healthcare professional, often a licensed physician or nurse, responsible for evaluating medical information, claims, or documentation to ensure accuracy, compliance, and quality. They typically review patient records, insurance claims, or clinical data and may use medical guidelines and coding systems in their assessments.
What are the key skills and qualifications needed to thrive as a Medical Reviewer, and why are they important?
To thrive as a Medical Reviewer, you need a thorough understanding of medical terminology, clinical research, and regulatory guidelines, usually backed by a medical or pharmacy degree. Familiarity with tools like MedDRA, safety databases, and document management systems, as well as certifications in pharmacovigilance, are commonly required. Strong analytical skills, attention to detail, and effective written communication set standout professionals apart in this role. These skills ensure accurate evaluation of medical documents, regulatory compliance, and the safety of patients participating in clinical trials.
What is the difference between Medical Reviewer vs Medical Writer?
| Aspect | Medical Reviewer | Medical Writer |
|---|---|---|
| Required Credentials | Medical degree (MD, DO, PharmD), licensure often preferred | Background in life sciences, writing skills, often with a degree in related fields |
| Work Environment | Pharmaceutical companies, CROs, regulatory agencies, hospitals | Pharmaceutical companies, marketing agencies, publishing firms |
| Employer & Industry Usage | Review clinical data, regulatory documents, ensuring accuracy | Create scientific content, clinical study reports, marketing materials |
Medical Reviewers primarily verify the accuracy and compliance of clinical and regulatory documents, requiring medical credentials. Medical Writers focus on creating clear, accurate scientific content, often with a background in life sciences. Both roles are essential in the healthcare and pharmaceutical industries but serve different functions in the documentation process.
More about Medical Reviewer jobs
What cities are hiring for Medical Reviewer jobs? Cities with the most Medical Reviewer job openings:
What are the most commonly searched types of Medical Reviewer jobs? The most popular types of Medical Reviewer jobs are:
Who are the top companies hiring for Medical Reviewer jobs? The top employers for Medical Reviewer jobs are:
What states have the most Medical Reviewer jobs? States with the most job openings for Medical Reviewer jobs include:
What job categories do people searching Medical Reviewer jobs look for? The top searched job categories for Medical Reviewer jobs are:
What are popular job titles related to Medical Reviewer jobs? For Medical Reviewer jobs, the most frequently searched job titles are:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 4 days ago
Job description
Summary
 This open position is within one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers for more than 50 years.
Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need strong clinical and computer skills. It will be best for someone who is self-motivated and has excellent time management skills. Excellent for those individuals looking to transition their career from the physical and time demands of direct patient care. The role provides the opportunity for a good home/work life balance with a Monday through Friday daytime schedule, some flexibility, and no regular weekends or holidays.
Description
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Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Logistics: CGS (cgsadmin.com) - one of BlueCross BlueShield of South Carolina's subsidiary companies.
Government Clearance:This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.
Sponsorship: This position is not eligible for sponsorship now or in the future.
Location:
Candidates who live within 40 miles of Nashville, TN, or Columbia, SC may be considered for a hybrid schedule.
Qualified candidates outside the local area will also be considered for a work from home schedule. You must have high-speed internet (non-satellite) and a private home office to work from home.
Work hours are 8:00 a.m. to 4:30 p.m. CT, Monday through Friday.
What You Will Do:
Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, correct coding for claims/operations. Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines. Determines medical necessity, appropriateness, and/or reasonableness and necessity for coverage and reimbursement. Monitors process's timeliness in accordance with contractor standards. Documents medical rationale to justify payment or denial of services and/or supplies.
Educates internal and external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc., in accordance with contractor guidelines.
Participates in quality control activities in support of the corporate and team-based objectives. Provides guidance, direction, and input as needed to LPN team members. Provides education to non-medical staff through discussions, team meetings, classroom participation, and feedback. Assists with special projects and specialty duties/responsibilities as assigned by management.
To Qualify For This Position, You'll Need:
Required Licenses and Certificates: Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).
Required Education: Associate in a job-related field OR graduate of an Accredited School of Nursing.
Required Work Experience: Two years of clinical nursing experience.
Required Skills and Abilities: Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated oral and written communication skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools: Microsoft Office.
We Prefer That You Have:
Five years of clinical experience as a Registered Nurse, including two years in the following specialty area(s): Outpatient Surgical, Pain Management, Cosmetic Surgery, Prior Authorization, Medical Review, Medicare Part A, or Utilization Management.
Ability to work with multiple Windows-based programs simultaneously.
Intermediate Word, Excel, and Outlook skills.
Our Comprehensive Benefits Package Includes:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What To Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Pay Range Information:
Range Minimum
$ 47,263
Range Midpoint
$ 68,905
Range Maximum
$ 90,548
Pay Transparency Statement: Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.
Some states have required notifications. Here's more information.