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One Call Clinical Reviewer Jobs (NOW HIRING)

Astyra Corporation

Clinical Reviewer

Indianapolis, IN · Remote

$36 - $40/hr

Job Summary The purpose of this position is to utilize clinical expertise to review medical records ... * 1+ year of InterQual and/or Milliman Care Guidelines (MCG) experience * Strong knowledge of ...

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mycenters

UM Clinical Reviewer

Pompano Beach, FL · On-site

One of the fastest growing Managed Long-Term Care company in New York, Centers Plan For Healthy ... The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify ...

TriWest Healthcare

ABA Clinical Reviewer

Phoenix, AZ · On-site

... One (1) year managed care experience • Experience with TRICARE ABA service delivery and ... the review of clinical decision support tools and provider education materials to ensure ...

Acentra Health, LLC

Clinical Reviewer (SCA-Remote)

The Clinical Reviewer utilizes clinical expertise during beneficiary interaction in conjunction ... Assesses, evaluates, and addresses daily workload and call queues; adjusts work schedules daily to ...

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One Call Clinical Reviewer information

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How much do one call clinical reviewer jobs pay per hour?

As of Jun 4, 2026, the average hourly pay for one call clinical reviewer in the United States is $35.92, according to ZipRecruiter salary data. Most workers in this role earn between $31.25 and $40.38 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a One Call Clinical Reviewer, and why are they important?

To excel as a One Call Clinical Reviewer, you need a solid background in healthcare, clinical assessment skills, and typically a current RN, PT, or OT license. Familiarity with utilization review software, electronic medical records (EMRs), and knowledge of regulatory guidelines such as Medicare and Medicaid is important. Strong analytical thinking, attention to detail, and effective written and verbal communication skills help you stand out in this role. These abilities ensure accurate, timely clinical reviews and facilitate appropriate care decisions in a regulatory-compliant manner.

What are some common challenges faced by One Call Clinical Reviewers, and how can applicants prepare for them?

One Call Clinical Reviewers often face the challenge of managing a high volume of case reviews while ensuring accuracy and compliance with clinical guidelines. Balancing efficiency with attention to detail is essential, as reviewers are responsible for making evidence-based decisions that impact patient care and insurance approvals. To prepare, applicants should familiarize themselves with current clinical protocols and develop strong organizational and communication skills, as collaboration with physicians, case managers, and insurance representatives is frequent.

What is a One Call Clinical Reviewer?

A One Call Clinical Reviewer is a healthcare professional, often a nurse or physician, who evaluates medical records and treatment requests to determine if they meet established clinical guidelines and policies. Their primary role is to ensure that patients receive appropriate, evidence-based care while helping manage costs and utilization for insurance or workers’ compensation cases. They work within the One Call organization, which specializes in healthcare solutions, particularly for workers’ compensation and related services. Clinical reviewers must possess strong analytical skills and a thorough understanding of medical standards and regulations.

What is the difference between One Call Clinical Reviewer vs Medical Case Reviewer?

AspectOne Call Clinical ReviewerMedical Case Reviewer
CredentialsRN or licensed healthcare professionalRN or licensed healthcare professional
Work EnvironmentRemote, healthcare insurance, or third-party review companiesRemote, insurance companies, or healthcare organizations
Employer & IndustryThird-party review firms, insurance carriersInsurance companies, healthcare organizations

Both roles require healthcare credentials and involve reviewing medical cases remotely. The main difference lies in the specific job focus: One Call Clinical Reviewers often handle urgent or immediate case assessments, while Medical Case Reviewers may focus on comprehensive case evaluations for insurance claims or treatment plans.

Infographic showing various One Call Clinical Reviewer job openings in the United States as of May 2026, with employment types broken down into 88% Full Time, 9% Part Time, and 3% Contract. Highlights an 85% In-person, and 15% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.
Clinical Reviewer

Clinical Reviewer

Astyra Corporation

Indianapolis, IN • Remote

$36 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 2 days ago

Job description

Job Summary

The purpose of this position is to utilize clinical expertise to review medical records against established criteria in accordance with contract requirements.

Location: Remote (U.S.-based)
Licensure Requirement: Must hold an active clinical license in the State of Indiana or a Compact State license

Work Schedule:

  • 40 hours per week
  • Weekend and/or holiday availability required 

Training Requirement:

  • Must be fully available to attend 100% of training
  • Schedule: Monday–Friday, 9:00 AM – 6:00 PM EST
  • Duration: Minimum of 3 weeks
Key Responsibilities
  • Ensure accuracy and timeliness of all review cases in accordance with contract requirements
  • Manage daily workload and queues; adjust workflow as needed to meet departmental demands
  • Collaborate with Supervisor on quality monitoring and improvement activities
  • Maintain current knowledge of clinical practices and review processes
  • Serve as a liaison for providers regarding customer service issues and resolution
  • Perform various review types as assigned based on workload
  • Build and maintain professional relationships with internal and external stakeholders
  • Attend required trainings and team meetings
  • Cross-train to support business and client needs
  • Comply with all corporate policies, including HIPAA Privacy and Security regulations

Note: Responsibilities may evolve based on business needs.
 

Required Qualifications
  • Active, unrestricted LPN/LVN or RN license in Indiana or Compact State
  • Associate’s degree (Bachelor’s preferred) or diploma from an accredited nursing program
  • 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience
  • 2+ years of medical necessity review experience
  • 1+ year of InterQual and/or Milliman Care Guidelines (MCG) experience
  • Strong knowledge of medical records, terminology, and disease processes
  • Excellent clinical assessment and critical thinking skills
  • Strong written and verbal communication skills
  • Ability to navigate multiple systems efficiently
  • Strong organizational skills and flexibility
Preferred Qualifications
  • 3+ years of clinical experience (acute care, behavioral health, and/or med-surgical)
  • Knowledge of NCQA and URAC standards
  • Experience working in a team-based environment
  • Proficiency in Microsoft Office
  • Strong time management and prioritization skills
  • Demonstrated ability to maintain confidentiality and ensure HIPAA compliance
Weekend and holiday flexibility is required
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
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