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Remote Clinical Reviewer Jobs in Arizona (NOW HIRING)

YO AI Labs

Clinicia Expert - Remote

Phoenix, AZ · Remote

$150 - $200/hr

Clinician Expert Remote Job Type: Contractor Location: Remote Job Overview We are seeking ... Author and review clinical evaluation tasks requiring advanced oncology and hematology expertise.

Tango Care

Physician Reviewer (Remote)

Phoenix, AZ · On-site +1

Remote - flexible hours Essential Functions: * Perform focused real-time case reviews by reviewing ... Applies medical judgement and pertinent evidence based clinical guidelines to determine medical ...

YO AI Labs

Clinical Document Author - Remote

Phoenix, AZ · Remote

$50 - $80/hr

Remote Job Type: Contractor Pay: $50-$80/hour Job Overview We are seeking an experienced Medical ... Author and review Clinical Study Reports (CSRs) and other regulatory documents. * Interpret ...

YO AI Labs

Hematology Expert - Remote

Phoenix, AZ · Remote

$150 - $200/hr

Hematology Expert Remote Job Type: Contractor Location: Remote Job Overview We are seeking ... Author and review clinical evaluation tasks requiring advanced oncology and hematology expertise.

YO AI Labs

Oncology Expert - Remote

Phoenix, AZ · Remote

$150 - $200/hr

Oncology Expert Remote Job Type: Contractor Location: Remote Job Overview We are seeking ... Author and review clinical evaluation tasks requiring advanced oncology and hematology expertise.

Valenz Health

Clinical Bill Review Analyst

Phoenix, AZ · On-site +1

As a Clinical Bill Review Analyst, you'll review claims upfront and take a deeper dive to catch ... This is a fully remote position, and we'll provide all the necessary equipment! * Work Environment:

Danaher

Principal Clinical Scientist

Phoenix, AZ · On-site +1

... remote based (can also be onsite in Chaska, MN). At Danaher Diagnostics, our vision is to be the ... Author and review clinical and regulatory documentation-including study reports, technical files ...

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Remote Clinical Reviewer information

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How much do remote clinical reviewer jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for remote clinical reviewer in Arizona is $33.47, according to ZipRecruiter salary data. Most workers in this role earn between $29.13 and $37.64 per hour, depending on experience, location, and employer.

What is a remote clinical reviewer?

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 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.

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.

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 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.

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For Remote Clinical Reviewer jobs in Arizona, the most frequently searched job titles are:

What job categories do people searching Remote Clinical Reviewer jobs in Arizona look for?

The top searched job categories for Remote Clinical Reviewer jobs in Arizona are:

What cities in Arizona are hiring for Remote Clinical Reviewer jobs?

Cities in Arizona with the most Remote Clinical Reviewer job openings:

Remote Clinical Reviewer jobs near you
Infographic showing various Remote Clinical Reviewer job openings in Arizona as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $69,619 per year, or $33.5 per hour.

Initial Clinical Reviewer - Remote - AZ

Blue Cross Blue Shield of Arizona

Phoenix, AZ

Full-time

Re-posted 28 days ago

Blue Cross Blue Shield Of Arizona rating

5.9

Company rating: 5.9 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

295th of 315 rated insurance

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
  • Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
  • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
  • Onsite: daily onsite requirement based on the essential functions of the job
  • Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
  • Responsible for identifying, researching, processing, resolving, and responding to inquiries from internal and external customers with emphasis on excellence, privacy, compliance and versatility within the health insurance industry.

QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
  • 2 years of experience in clinical field of practice, health insurance, or other health care related field

Required Education
  • Associate's Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program
Required Licenses
  • Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an LPN.

Required Certifications
  • N/A

PREFERRED QUALIFICATIONS
Preferred Work Experience
  • 3 years of experience in clinical field of practice, health insurance, or other health care related field
Preferred Education
  • Bachelor's Degree in Nursing or related field of study
Preferred Licenses
  • Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse
Preferred Certifications
  • N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
  • Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.

  • Answer a diverse and high volume of health insurance related customer calls or correspondence on a daily basis.
  • Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
  • Maintain complete and accurate records per department policy.
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
  • Explain to customers a variety of information concerning the organization's services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
  • Demonstrate ability to apply plan policies and procedures effectively.
  • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
  • When indicated to assist with team/project functions:
    • Collaborate with team to distribute workload/work tasks;
    • Monitor and report team tasks;
    • Communicate team issues and opportunities for improvement to supervisor/manager;
    • Support/mentor team members.
  • Participate in continuing education and current developments in the fields of medicine and managed care.
  • Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
  • The position has an onsite expectation of 0 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements

  • Perform all other duties as assigned.

COMPETENCIES
REQUIRED COMPETENCIES
Required Job Skills
  • Intermediate PC proficiency
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones

Required Professional Competencies
  • Maintain confidentiality and privacy
  • Strong current clinical knowledge
  • Practice interpersonal and active listening skills to achieve customer satisfaction
  • Compose a variety of business correspondence
  • Interpret and translate policies, procedures, programs and guidelines
  • Capable of investigative and analytical research
  • Navigate, gather, input and maintain data records in multiple system applications
  • Follow and accept instruction and direction
  • Establish and maintain working relationships in a collaborative team environment
  • Organizational skills with the ability to prioritize tasks and work with multiple priorities
  • Independent and sound judgment with good problem solving skills

Required Leadership Experience and Competencies
  • Resolve conflicts
  • Represent BCBSAZ in the community

PREFERRED COMPETENCIES
Preferred Job Skills
  • Advanced PC proficiency
  • Knowledge of CPT-4 and ICD-9 coding

Preferred Professional Competencies
  • Knowledge of managed care, utilization management, and quality management
  • Working knowledge of McKesson InterQual® criteria

Preferred Leadership Experience and Competencies
  • N/A

Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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