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Remote Clinical Reviewer Jobs (NOW HIRING)

Comagine Health

Clinical Reviewer

We go beyond merely providing a remote work option; we support and embrace it. We offer ... Apply clinical review criteria , organizational policies, guidelines, and screening tools ...

Comagine

Clinical Reviewer

This is a remote position based in Oregon and travel is required. Why Comagine Health? Comagine ... Clinical documentation review expertise, including use of the Oregon Health Plan Prioritized List ...

Blue Cross of Idaho

Clinical Reviewer

Meridian, TX · On-site +1

... Remote; #LI-Hybrid. We're looking for a Clinical Reviewer with: Experience: 3 years' relevant ... experience Education: Associates Degree in Nursing or Bachelor's Degree in Social Work; or ...

Astyra Corporation

Clinical Reviewer

Indianapolis, IN · Remote

$38 - $40/hr

Remote (U.S.-based) Licensure Requirement: Must hold an active clinical license in the State of ... Ensure accuracy and timeliness of all review cases in accordance with contract requirements

Jobgether

Clinical Reviewer

$28.37 - $32/hr

Our partner is looking for a Clinical Reviewer based in the United States. This role plays a key part in ensuring the medical appropriateness and quality of clinical determinations within a ...

New

Comagine

Clinical Reviewer RN - Alabama

Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission ... We go beyond merely providing a remote work option; we support and embrace it. We offer ...

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Remote Clinical Reviewer information

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How much do remote clinical reviewer jobs pay per hour?

As of Jun 30, 2026, the average hourly pay for remote 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 Remote Clinical Reviewers?

Remote Clinical Reviewers are healthcare professionals, often nurses or physicians, who evaluate medical records and treatment plans from a remote location to ensure they meet clinical guidelines and insurance requirements. They assess the necessity, appropriateness, and quality of care provided to patients, often working for insurance companies, healthcare organizations, or third-party review agencies. This role typically involves reviewing documentation, making recommendations, and communicating findings electronically or by phone. The position allows for flexible, home-based work while contributing to healthcare quality and compliance.

What is the difference between Remote Clinical Reviewer vs Remote Medical Reviewer?

AspectRemote Clinical ReviewerRemote Medical Reviewer
Required CredentialsRN, LPN, or other healthcare licenses; clinical experienceMD or DO license; medical degree; clinical experience
Work EnvironmentHome-based, healthcare organizations, insurance companiesHome-based, insurance companies, healthcare organizations
Employer & Industry UsageInsurance, healthcare providers, government programsInsurance, healthcare, legal medical review
Common Search & ComparisonYesYes

Remote Clinical Reviewers typically hold nursing or healthcare licenses and focus on reviewing clinical documentation and patient care. Remote Medical Reviewers usually have medical degrees and perform in-depth medical assessments, often for insurance claims or legal cases. Both roles are home-based and serve similar industries, but the Medical Reviewer requires a medical degree and broader clinical expertise.

How does a Remote Clinical Reviewer typically collaborate with other healthcare professionals while working offsite?

Remote Clinical Reviewers regularly coordinate with physicians, nurses, and case managers through secure digital platforms, such as video conferencing, email, and electronic health record systems. Despite working remotely, they are integral to interdisciplinary teams and often participate in virtual meetings to discuss patient cases, clarify documentation, and ensure compliance with clinical guidelines. Building strong communication skills and familiarity with collaboration tools is essential for success in this role, as frequent interaction with both internal teams and external providers is a common aspect of daily responsibilities.

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

To thrive as a Remote Clinical Reviewer, you need a healthcare background such as RN, LPN, or other clinical licensure, along with strong knowledge of medical guidelines and utilization review processes. Familiarity with electronic medical record (EMR) systems, medical coding, and utilization management software is typically required. Attention to detail, analytical thinking, and clear written communication are crucial soft skills for reviewing patient cases and collaborating with remote teams. These skills and qualifications ensure accurate and timely clinical assessments, support compliance, and help facilitate appropriate patient care decisions in a virtual environment.

What Does a Remote Clinical Reviewer Do?

A remote clinical reviewer works from home reviewing medical records and claims for inpatient and outpatient services. Your responsibilities include executing a thorough review of patient medical records, submitting documentation to insurance companies, and ensuring accurate, timely, and secure processing of patient information. As a clinical reviewer, your duties span determining coverage for diagnosis and treatment, reviewing appeals, and processing correspondence. You provide remote support and expertise to department care coordinators, interact with teams and department heads as necessary, and request additional information for processing records as necessary.

More about Remote Clinical Reviewer jobs
What cities are hiring for Remote Clinical Reviewer jobs? Cities with the most Remote Clinical Reviewer job openings:
What states have the most Remote Clinical Reviewer jobs? States with the most job openings for Remote Clinical Reviewer jobs include:
What job categories do people searching Remote Clinical Reviewer jobs look for? The top searched job categories for Remote Clinical Reviewer jobs are:
Remote Clinical Reviewer jobs near you
Infographic showing various Remote Clinical Reviewer job openings in the United States as of June 2026, with employment types broken down into 68% Full Time, 21% Part Time, and 11% Contract. Highlights an 37% Physical, 3% Hybrid, and 60% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.
Clinical Reviewer

Clinical Reviewer

Comagine Health

Remote

Other

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Why Comagine Health?
Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years.
We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes.
Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.
We believe in an environment that allows you to thrive both personally and professionally. That's why we offer benefits that include:
  • Medical, dental and vision insurance
  • Paid time off for vacation, illness, and volunteering
  • Retirement savings plan with employer contribution
  • Adoption financial assistance
  • Paid parental leave.
  • And much more!
Position Overview
We are seeking a Clinical Utilization Review Nurse (RN) to assess the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective utilization management reviews. This full-time, remote position supports high-quality, appropriate, and cost-effective care while ensuring compliance with clinical criteria, organizational policies, and contract requirements specific to New Mexico.
Key Responsibilities
  • Conduct prospective, concurrent, and retrospective utilization management reviews
  • Apply clinical review criteria, organizational policies, guidelines, and screening tools (InterQual)
  • Consult with physician/practitioner consultants when services do not meet medical necessity criteria
  • Collaborate with internal teams and refer cases for additional review or escalation as appropriate
  • Refer cases to management when required
  • Provide clinical and utilization review subject matter expertise
  • Respond to provider, customer, and stakeholder questions regarding determinations and processes
  • Conduct outreach to providers, case managers, consultants, and community support coordinators to obtain additional clinical information
  • Maintain accurate documentation and comply with all regulatory and contract standards
Education & Experience
  • BA/BS in Nursing
    • Equivalent combination of education and/or related experience may be considered depending on contract
  • Minimum of 3 years of direct patient care (clinical) experience
Licensure
  • Current, active, unrestricted RN license
    • Must meet New Mexico state and contract-specific requirements
Required Skills & Competencies
  • Experience with InterQual Criteria
  • Strong proficiency in Microsoft Office Suite and familiarity with database systems
  • Excellent written and verbal communication skills
  • Strong organizational, analytical, and problem-solving abilities
  • Ability to manage multiple priorities in a fully remote, team-based environment
Work Environment
  • Full-Time
  • 100% Remote (United States)
  • Reliable, secure internet connection required
  • Must maintain licensure eligibility for assigned state contract

Equal Opportunity Employer
Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.
Physical Requirements & Work Environment
This position is primarily remote and performed in a home-based setting, requiring reliable internet access and a workspace free from significant distractions. The role involves frequent use of computers, phones, and virtual communication tools. Employees must be able to sit for extended periods, communicate effectively.
Some positions may require operating a motor vehicle for business purposes; in such cases, employees must maintain a valid driver's license and meet the organization's driving eligibility requirements. Occasional travel may be required for meetings, training, or other work-related events.
Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions.

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