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Remote Clinical Reviewer Jobs in Puerto Rico (NOW HIRING)

Epic Denials Management Operator

San Juan, PR · Remote

$17.75 - $23.50/hr

This is a primarily remote role supporting enterprise Epic support, with minimal travel and ... Review hospital account records and payer remittance records, communicate with relevant Client RCM ...

Advise on applicable transfer mechanisms and review/negotiate DPAs, vendor contracts, and data ... For field-based and remote-by-design roles the ability to physically travel to visit customers ...

This is a field-based/remote position. Candidates can reside in Newport News, Hampton, Norfolk ... Review, analyze, and address gaps in service excellence, policies, and/or procedures proactively ...

This is a field-based/remote position. Candidates can reside in Newport News, Hampton, Norfolk ... Review, analyze, and address gaps in service excellence, policies, and/or procedures proactively ...

Advise on applicable transfer mechanisms and review/negotiate DPAs, vendor contracts, and data ... For field-based and remote-by-design roles the ability to physically travel to visit customers ...

This is a field-based/remote position. Candidates can reside in Newport News, Hampton, Norfolk ... Review, analyze, and address gaps in service excellence, policies, and/or procedures proactively ...

Remote Clinical Reviewer information

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.

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

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

What cities in Puerto Rico are hiring for Remote Clinical Reviewer jobs?

Cities in Puerto Rico with the most Remote Clinical Reviewer job openings:

Infographic showing various Remote Clinical Reviewer job openings in Puerto Rico as of August 2026, with employment types broken down into 3% As Needed, 71% Full Time, 18% Part Time, and 8% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

Staff Psychiatric Mental Health Nurse Practitioner (PMHNP) - Remote | Telehealth | Full-Time or Part

Legion Health

Caguas, PR • On-site, Remote

$150K - $300K/yr

Full-time

Posted 21 days ago


Key responsibilities

  • Provide excellent patient care for conditions including depression, anxiety, ADHD, insomnia, PTSD, bipolar disorder, etc.

  • Perform comprehensive psychiatric assessments, including mental-health history, medical history, diagnostic evaluation, and risk analysis.

  • Create and execute individualized treatment plans that may combine medication management and brief psychotherapy.


Job description

[We show compassion to heal minds.]
About Legion Health
Legion Health is a technology-forward psychiatry company delivering world-class outpatient mental health care while expanding access for patients through insurance.
We are seeking exceptional Psychiatric Mental Health Nurse Practitioners (PMHNPs) across the United States who are passionate about evidence-based psychiatry and want the time, support, and clinical autonomy needed to provide exceptional patient care.
Our innovative model combines the stability of a traditional hospital position with the flexibility of a private practice. We prioritize our clinicians' well-being and professional growth, offering a competitive compensation package and fostering a vibrant, collaborative culture.
Quality and patient experience are paramount to us. This means recruiting exceptional providers, championing evidence-based protocols, and displaying compassion in every patient interaction. Our exceptional PMHNPs operate with clinical autonomy, supported by experienced psychiatrists through consults and peer case reviews.
Our vision is to pioneer a new era of medicine by delivering world-class psychiatry. We believe in a future where every person can access the compassionate, high-quality care they need.
About the Role
Practice at the top of your license, from wherever you do your best work. This role is designed for PMHNPs who want meaningful clinical autonomy without having to build and operate a private practice alone.
We are looking for clinically excellent, patient-centered PMHNPs to provide psychiatric care through telehealth. Full-time and part-time positions are available.
Benefits
Legion's model is built to give clinicians more time for patients, fewer administrative distractions, and the support of a high-caliber psychiatric community.
  • Flexibility: Set your own schedule for optimal work-life balance.
  • Work from Home: See patients from the comfort of your home via telehealth.
  • Significant Administrative Support: You focus on patient care, and we'll handle scheduling, insurance verification, billing, prior authorizations, pharmacy coordination, etc.
  • Patient Acquisition: Unlike with a private practice, we'll work to fill your schedule, so you don't have to do your own marketing.
  • Collaborating Physician Coverage: Where applicable, we provide your collaborating psychiatrist and fully cover the costs.
  • Competitive Pay: We compensate our providers at market-leading rates.
  • Weekly Pay: We pay our providers every week for immediate financial benefit and planning ease.
  • Legal Protection: We provide full malpractice insurance coverage.
  • Clinical Autonomy: We hire the most skilled providers and trust them to do what's best for patients.
  • Technical Support: We cover the costs for you to have best-in-class EHR, e-Prescribe, and AI tools.
  • Credentialing Support: We handle all aspects and costs of credentialing with a large number of insurance plans, including commercial, ACA, and government, ensuring your legal and effective authorization within insurance networks.
  • Licensure and DEA Coverage: We'll reimburse you for all fees associated with getting licensed in other states as required by Legion.
  • Commitment to Responsible Prescribing and High-Quality Care: We have rigorous, evidence-based protocols and provide objective diagnostic tools to ensure responsible and ethical prescriptions of controlled substances.
  • Community of Clinical Excellence: You will work alongside the most talented PMHNPs and psychiatrists in the world. Our current PMHNPs have trained at some of the country's most prestigious institutions, including Vanderbilt, UT Austin, Johns Hopkins, Columbia, NYU, and UTHealth Houston.
  • Opportunities for Professional Growth: As we expand, we intend to promote clinical leadership from the best of our active providers.
  • Culture of Excellence through Innovation: Actively participate in ushering in a new era of mental health care through superior clinical care and technology.
  • Resources: We provide premium subscriptions to resources such as UpToDate and Carlat.
  • Exclusive Events: Engage with your colleagues through exclusive in-person and virtual events.

• Responsibilities
  • Provide excellent patient care for conditions including depression, anxiety, ADHD, insomnia, PTSD, bipolar disorder, etc.
  • Perform comprehensive psychiatric assessments, including mental-health history, medical history, diagnostic evaluation, and risk analysis.
  • Create and execute individualized treatment plans that may combine medication management and brief psychotherapy.
  • Provide compassionate, respectful, and patient-centered care.
  • Use evidence-based clinical protocols and responsible prescribing practices.
  • Collaborate with psychiatrists and clinical peers through consultations and case reviews.
  • Use technology and operational systems effectively to deliver reliable telehealth care.

Qualifications
  • Active, unrestricted state-issued authority to practice as a PMHNP in at least one U.S. state or jurisdiction.
  • Strong clinical assessment, diagnostic, and medication-management skills.
  • Excellent communication and interpersonal skills.
  • Comfort providing care remotely and using electronic health record systems.
  • Commitment to patient-centered, compassionate, evidence-based care.

Role Logistics
  • Location: Fully remote within the United States.
  • Schedule: Full-time or part-time positions are available.
  • Compensation: $150K-$300K per year, depending on completed patient-care hours.

Clinical Advisory Board
Legion's Clinical Advisory Board brings together nationally recognized psychiatrists, physician executives, telepsychiatry pioneers, and primary-care leaders. Working closely with Legion's medical leadership, they help shape our clinical quality standards, evidence-based care protocols, prescribing safeguards, risk-management practices, and continuous quality-improvement efforts as the company scales.
Members of our Clinical Advisory Board include:
  • Madhukar Trivedi, M.D. - Psychiatrist; Professor of Psychiatry and Distinguished Chair in Mental Health at UT Southwestern
  • Alexander Ruvalcaba, M.D. - Psychiatrist; Physician Executive at MultiCare Behavioral Health Network
  • Jon Kole, M.D. - Psychiatrist; Senior Medical Director at Headspace
  • Liberty Eberly, D.O. - Psychiatrist; Co-Founder and Former Chief Medical Officer at innovaTel Telepsychiatry
  • John Lusins, M.D. - Psychiatrist; Founder and President at South Texas Mental Health Associates
  • Jacqueline Champlain, M.D. - Family Medicine Physician; Lead Physician at WellMed and Fellow of the American Academy of Family Physicians

Bring Your Best Clinical Work to Legion
If you are a thoughtful, evidence-based PMHNP who wants the flexibility of remote practice, meaningful clinical autonomy, robust operational support, and a community committed to excellent psychiatric care, we would be excited to learn more about you.
Equal Employment Opportunity
Legion Health is proud to be an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees, contractors, and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, genetic information, or any other protected characteristic under applicable law. We encourage applicants from all backgrounds to apply.