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Physician Reviewer Jobs (NOW HIRING)

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Physician Reviewer

Richardson, TX · On-site

Physician Reviewer Job Location: Richardson, TX Job Duration: 24 Months (possibility of extension) Schedule is M-F, but may need to work 3-4 weekends per year remote, but must reside within one of ...

w3r Consulting

Physician Reviewer

Houston, TX · On-site

Participates in the Physician Review Units' appeal process of service denials. * Participates in the development of Physician Review Units' policies and procedures. * Actively participates in all ...

w3r Consulting

Physician Reviewer

Chicago, IL · On-site

Participates in the Physician Review Units' appeal process of service denials. * Participates in the development of Physician Review Units' policies and procedures. Actively participates in all unit ...

Mindlance

Physician Reviewer

Chicago, IL · On-site

Participates in the Physician Review Units' appeal process of service denials. Participates in the development of Physician Review Units' policies and procedures. Actively participates in all unit ...

w3r Consulting

Physician Reviewer

Houston, TX · On-site

Participates in the Physician Review Units' appeal process of service denials. * Participates in the development of Physician Review Units' policies and procedures. * Actively participates in all ...

VIVA USA INC

Physician Reviewer

Chicago, IL · On-site +1

Participates in the Physician Review Units' appeal process of service denials. Participates in the development of Physician Review Units' policies and procedures. Actively participates in all unit ...

Med Review Inc

Physician Reviewer

Manhattan, NY · On-site

We are seeking a highly experienced DRG Clinical Physician Reviewer to join our growing clinical review team. This is a fully remote opportunity for a physician with a strong background in ...

Dane Street, LLC

Physician Reviewer

JOB SUMMARY As a Physician Reviewer/Advisor for Disability Peer Review, you will utilize clinical expertise to review medical records provided and return an independent, professional opinion on the ...

w3r Consulting

Physician Reviewer

Richardson, TX · On-site

Participates in the development of Physician Review Units' policies and procedures. * Actively participates in all unit continuous quality improvement activities. * Other duties as assigned by the ...

Dane Street, LLC

Physician Reviewer

... physician to process utilization reviews . Worker's Compensation experience is preferred but, not required. This telework opportunity provides the ability to customize your schedule and caseload ...

MedReview

Physician Reviewer

Manhattan, NY · On-site +1

We are seeking a highly experienced DRG Clinical Physician Reviewer to join our growing clinical review team. This is a fully remote opportunity for a physician with a strong background in ...

MedReview

Physician Reviewer

Manhattan, NY · Remote

We are seeking a highly experienced DRG Clinical Physician Reviewer to join our growing clinical review team. This is a fully remote opportunity for a physician with a strong background in ...

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Physician Reviewer information

See salary details

$79.5K

$149K

$310.5K

How much do physician reviewer jobs pay per year?

As of Jul 26, 2026, the average yearly pay for physician reviewer in the United States is $149,049.00, according to ZipRecruiter salary data. Most workers in this role earn between $81,000.00 and $216,500.00 per year, depending on experience, location, and employer.

What are some typical challenges Physician Reviewers face when evaluating complex medical cases?

Physician Reviewers often encounter cases with incomplete documentation or ambiguous clinical details, which can make it challenging to render objective decisions. They must balance evidence-based guidelines with individual patient circumstances while maintaining impartiality. Additionally, Physician Reviewers may need to communicate their findings clearly to both medical professionals and non-clinical staff, requiring strong written and verbal communication skills. Staying updated with evolving medical standards and payer policies is also essential for success in this role.

What is a Physician Reviewer?

A Physician Reviewer is a licensed medical doctor who evaluates clinical information and medical records to ensure that healthcare services are medically necessary and appropriate. They typically work for insurance companies, healthcare organizations, or government agencies, reviewing claims, appeals, and utilization management decisions. Their expertise helps determine whether treatments meet established guidelines and standards of care, promoting quality and cost-effective healthcare. Physician Reviewers play a key role in maintaining ethical and evidence-based medical practices.

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

To thrive as a Physician Reviewer, you need a valid medical degree, clinical experience, and strong knowledge of evidence-based medicine and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications such as board certification or medical licensure are typically required. Excellent analytical skills, attention to detail, and effective written and verbal communication help in making sound clinical determinations and collaborating with healthcare teams. These skills ensure accurate, fair, and efficient medical reviews that support quality care and regulatory compliance.

What is the difference between Physician Reviewer vs Medical Director?

AspectPhysician ReviewerMedical Director
CredentialsMedical degree, medical license, often board-certifiedMedical degree, medical license, often board-certified, leadership experience
Work EnvironmentReviewing medical records, claims, or cases, often remotely or in officeOverseeing clinical operations, managing teams, strategic planning
Employer & Industry UsageInsurance companies, healthcare organizations, legal firmsHospitals, healthcare systems, insurance companies
Common Search & ComparisonPhysician Reviewer vs Medical Director

The main difference is that Physician Reviewers focus on evaluating medical records and claims to ensure accuracy and compliance, often working independently or remotely. Medical Directors, on the other hand, hold leadership roles, overseeing clinical operations and guiding healthcare policies. Both roles require medical credentials, but Medical Directors typically have additional leadership experience and responsibilities.

More about Physician Reviewer jobs
What cities are hiring for Physician Reviewer jobs? Cities with the most Physician Reviewer job openings:
What are the most commonly searched types of Physician Reviewer jobs? The most popular types of Physician Reviewer jobs are:
Who are the top companies hiring for Physician Reviewer jobs? The top employers for Physician Reviewer jobs are:
What states have the most Physician Reviewer jobs? States with the most job openings for Physician Reviewer jobs include:
What job categories do people searching Physician Reviewer jobs look for? The top searched job categories for Physician Reviewer jobs are:
Physician Reviewer jobs near you
Infographic showing various Physician Reviewer job openings in the United States as of July 2026, with employment types broken down into 1% Locum Tenens, 2% As Needed, 83% Full Time, 11% Part Time, and 3% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $149,049 per year, or $71.7 per hour.
Physician Reviewer

Physician Reviewer

Independent Living Systems

Miami, FL • On-site

Full-time

Posted 24 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Physician Reviewer to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Physician Reviewer plays an essential role in ensuring the quality and appropriateness of healthcare services by conducting thorough medical record reviews and assessments. The Physician Reviewer will evaluate clinical documentation to determine the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. The Physician Reviewer collaborates with healthcare providers, and utilization and case management teams to support decision-making processes related to patient care and reimbursement. By applying clinical expertise and evidence-based guidelines, the Physician Reviewer helps to promote optimal patient outcomes in a cost effective manner. This role requires a strong commitment to accuracy, ethical standards, and continuous learning in a dynamic healthcare environment.

Minimum Qualifications:

  • Medical degree (MD or DO) from an accredited institution.
  • Active and unrestricted Florida medical license.
  • Minimum of 3 years clinical experience in a managed care setting.
  • Strong knowledge of clinical guidelines, and healthcare regulations.

Preferred Qualifications:

  • Experience in utilization review, medical auditing, or healthcare quality assurance.
  • Familiarity with insurance claims processes and healthcare reimbursement models.
  • Proficiency with electronic medical records (EMR) systems and medical review software.
  • Experience working in a managed care or health insurance environment.

Responsibilities:

  • Demonstrates commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Review requests for prior authorizations, inpatient and concurrent review, outpatient and procedural requests, and long term care services by analyzing medical records, clinical data, and treatment plans to assess the necessity and appropriateness of healthcare services.
  • Apply established clinical guidelines and criteria to evaluate patient care and support utilization management decisions.
  • Communicate findings and recommendations clearly to healthcare providers, utilization nurses and case managers.
  • Collaborate with interdisciplinary teams and participate in interdisciplinary care team rounds to review care plans, provide clinical guidance, resolve clinical questions and ensure compliance with regulatory and organizational standards.
  • Conduct peer-to-peer reviews and reconsiderations with providers requesting a review of denied services or submitting additional information to support a request for services.
  • Review grievances and appeals and apply established clinical guidelines and criteria to evaluate patient care and support utilization management decisions.
  • Document review outcomes accurately and maintain confidentiality of patient information in accordance with HIPAA regulations.
  • Participate in Medicaid Fair Hearings to present the clinical information and guidelines used to make determinations of coverage and medical necessity.
  • Performs other duties as assigned.


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