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Remote Chiropractic Clinical Reviewer Jobs in Boca Raton, FL

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Remote Chiropractic Clinical Reviewer information

What does a remote chiropractic clinical reviewer do?

A Remote Chiropractic Clinical Reviewer is a licensed chiropractor who evaluates medical records and treatment plans from a remote location, typically on behalf of insurance companies or healthcare organizations. Their primary responsibility is to assess the medical necessity, appropriateness, and efficiency of chiropractic care submitted for reimbursement or review. They ensure that treatments align with established clinical guidelines and provide recommendations or determinations regarding coverage. This role may also involve communicating with providers to clarify documentation and support quality assurance in healthcare delivery.

How does a remote chiropractic clinical reviewer typically interact with healthcare providers and insurance teams during a case review?

As a Remote Chiropractic Clinical Reviewer, you will frequently communicate with healthcare providers and insurance personnel through secure digital platforms, emails, and phone calls. Your role involves reviewing medical records and clinical documentation, then providing detailed reports or recommendations regarding the medical necessity of chiropractic treatments. Collaboration is key—while most of your work is independent, you may participate in virtual team meetings, case discussions, and peer reviews to ensure decisions adhere to industry and regulatory standards. This blend of autonomous work and professional interaction creates a dynamic and supportive remote environment.

What are the key skills and qualifications needed to thrive as a remote chiropractic clinical reviewer, and why are they important?

To thrive as a Remote Chiropractic Clinical Reviewer, you need a Doctor of Chiropractic (DC) degree, a valid chiropractic license, and a strong background in clinical documentation and case review. Familiarity with electronic health record (EHR) systems, utilization management software, and knowledge of insurance coding (ICD-10, CPT) are typically required. Strong attention to detail, analytical thinking, and effective written communication help reviewers clearly evaluate and document clinical cases. These skills and qualifications are vital to ensure accurate, compliant, and timely assessments that support quality patient care and insurance determinations.

What is the difference between Remote Chiropractic Clinical Reviewer vs Remote Chiropractic Claims Specialist?

AspectRemote Chiropractic Clinical ReviewerRemote Chiropractic Claims Specialist
Required CredentialsChiropractic license, clinical review experienceChiropractic knowledge, claims processing experience
Work EnvironmentReviewing patient records, clinical assessmentsProcessing insurance claims, customer service
Employer & Industry UsageHealthcare providers, insurance companies

The Remote Chiropractic Clinical Reviewer primarily evaluates patient records and clinical data to ensure proper care and compliance, requiring a chiropractic license. In contrast, the Remote Chiropractic Claims Specialist focuses on processing insurance claims related to chiropractic services, often without requiring a clinical license. Both roles are remote, serve healthcare and insurance industries, but differ in daily tasks and credential requirements.

What are the most commonly searched types of Chiropractic Clinical Reviewer jobs in Boca Raton, FL?

The most popular types of Chiropractic Clinical Reviewer jobs in Boca Raton, FL are:

What are popular job titles related to Remote Chiropractic Clinical Reviewer jobs in Boca Raton, FL?

For Remote Chiropractic Clinical Reviewer jobs in Boca Raton, FL, the most frequently searched job titles are:

What job categories do people searching Remote Chiropractic Clinical Reviewer jobs in Boca Raton, FL look for?

The top searched job categories for Remote Chiropractic Clinical Reviewer jobs in Boca Raton, FL are:

What cities near Boca Raton, FL are hiring for Remote Chiropractic Clinical Reviewer jobs?

Cities near Boca Raton, FL with the most Remote Chiropractic Clinical Reviewer job openings:

Remote Chiropractic Clinical Reviewer jobs near you
Infographic showing various Remote Chiropractic Clinical Reviewer job openings in Boca Raton, FL as of August 2026, with employment types broken down into 100% Part Time. Highlights an 100% Remote job distribution.

Manager, Clinical Appeals

Health Business Solutions LLC

Cooper City, FL • Remote

Full-time

Re-posted 25 days ago

Job description

Job Summary:

We are seeking an experienced and highly organized Manager of Clinical Appeals to lead our clinical appeals operations across commercial and government payers. This role is responsible for overseeing day-to-day activities of clinical appeal specialists, managing appeal strategy execution, ensuring quality and compliance, and meeting client-specific performance goals.

The ideal candidate brings a strong background in clinical review, medical necessity denials, payer appeal processes, and team leadership—ideally across both U.S. and offshore teams (e.g., Philippines). This position is critical to ensuring timely and effective resolution of denied claims, supporting revenue recovery efforts, and maintaining payer and regulatory compliance.

Key Responsibilities:

  • Manage the full-cycle clinical appeals process across multiple payer types, with a focus on government (e.g., Medicare, Medicaid) and commercial payers.
  • Lead and support a team of nurses, clinical reviewers, and appeal specialists—including potential offshore (Philippines-based) staff.
  • Monitor appeal workloads, productivity, and turnaround times to ensure all appeal deadlines and client service level agreements (SLAs) are met.
  • Review and approve complex or high-value clinical appeal cases, ensuring clinical accuracy and compliance with payer guidelines.
  • Maintain up-to-date knowledge of medical necessity criteria, payer policies, NCDs/LCDs, and applicable CMS regulations.
  • Train new and existing team members on clinical guidelines, appeal writing standards, and regulatory requirements.
  • Work cross-functionally with audit, legal, compliance, and operations teams to align on strategy and escalate trends or systemic payer issues.
  • Identify and implement process improvements to increase efficiency, reduce denials, and improve overturn rates.
  • Support the creation and refinement of appeal templates, clinical arguments, and documentation standards.
  • Generate and deliver performance and quality reports to leadership, identifying risks and opportunities for improvement.

Qualifications:

  • Registered Nurse (RN) or clinical degree required; Bachelor's degree in Nursing, Health Administration, or related field preferred.
  • 5+ years of experience in clinical appeals, utilization review, or medical necessity denials.
  • 2+ years in a leadership or supervisory role, preferably within a revenue cycle or payer appeals setting.
  • In-depth understanding of payer denial processes, especially Medicare Advantage, Medicaid Managed Care, and commercial plans.
  • Experience managing remote and/or offshore teams (Philippines experience preferred).
  • Strong working knowledge of ICD-10, CPT, and HCPCS coding as they relate to clinical justifications.
  • Excellent writing skills and the ability to clearly communicate complex clinical reasoning.
  • Familiarity with appeal submission portals, EHRs, and workflow platforms.
  • Knowledge of HIPAA, CMS, and NCQA standards.