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Remote Clinical Reviewer Jobs in Puerto Rico (NOW HIRING)

OncoHealth

Case Review Specialist - PR

Guaynabo, PR · On-site +1

Process cases and request/maintain clinical documentation and transmit timely determinations via ... Remote/hybrid experience preferred * A minimum of 2-4 years' administrative experience and/or ...

Deloitte

Hospital Billing Coordinator

San Juan, PR · Remote

$50K - $60K/yr

This is a primarily remote role supporting enterprise Epic implementation, with minimal travel and ... Review patient accounts, charge details, coding inputs, and supporting documentation for billing ...

Deloitte

Hospital Billing Analyst

San Juan, PR · Remote

$47K - $62K/yr

This is a primarily remote role supporting an enterprise Epic implementation, with minimal travel ... Review patient accounts, charge details, coding inputs, and supporting documentation for billing ...

Amgen

Senior Specialist, Quality Risk & Governance

Juncos, PR · On-site +1

$80K - $110K/yr

... Clinical, Pharmacovigilance, and Digital organizations to drive a modern, data-driven approach to ... Remote will be considered if applicable. Quality Risk Management (60%) In this role, you will ...

DaVita

Regional Operations Director (ROD)

San Juan, PR · Remote

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 ...

DaVita

Regional Operations Director (ROD)

San Juan, PR · Remote

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 ...

DaVita

Regional Operations Director (ROD)

San Juan, PR · Remote

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 ...

DaVita

Regional Operations Director (ROD)

San Juan, PR · Remote

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 ...

All JobsRemote Clinical Reviewer JobsRemote Clinical Reviewer Jobs in Puerto Rico

Remote Clinical Reviewer information

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 are popular job titles related to Remote Clinical Reviewer jobs in Puerto Rico? For Remote Clinical Reviewer jobs in Puerto Rico, the most frequently searched job titles are:
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:
Remote Clinical Reviewer jobs near you
Case Review Specialist - PR

Case Review Specialist - PR

OncoHealth

Guaynabo, PR • On-site, Remote

Full-time

Posted 28 days ago

Job description

About OncoHealth
OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment review and virtual care across all cancer types.
About the Role

The Case Review Specialist ensures that case documentation is provided by the provider for accurate and timely determinations and communicates with clinical and non-clinical staff to facilitate case discussions.
Primary Responsibilities
  • Flexible to work rotational shifts inside our office hours from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday – Friday 8:00 am to 8:00 pm AST, Saturdays 8:30 am - 5:00 pm AST, and On-Call Sundays (Office hours may change/extend upon operational needs) to include Holidays.
  • Process cases and request/maintain clinical documentation and transmit timely determinations via the company’s internal system and/or by phone to the provider and/or member and/or payer
  • Intake Pre-Authorization requests and/or inquiries on existing pre-authorizations via phone, email, fax or by the portal and ensuring they are responded/processed within the established metrics
  • Work collaboratively with clinical and non-clinical staff to facilitate case discussions
  • Fax intake and labeling on weekends/Holidays as needed
About You
  • Bachelor’s Degree or relevant experience preferred
  • Fully Bilingual (English and Spanish)
  • Remote/hybrid experience preferred
  • A minimum of 2-4 years’ administrative experience and/or customer service or relevant educational attainment required
  • Knowledge in pre-authorizations and health insurance client services departments are preferred
  • Implementation of systems for program effectiveness and productivity required
  • Systems/Tools: MS Office Suite proficient
About the Location
OncoHealth is committed to remote, hybrid or in office work options. Our Team in Puerto Rico reports to the office at least 2 times per month (advance notice provided/mandatory requirement) and can work remotely from home the rest of the days. Employees are welcome to work from the office every day if wanted.

Our Culture

Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first!

We offer a full benefit package on your first day, along with a company bonus. You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!
OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. All employment decisions are based on qualifications, merit, and business need.

The Opportunity

The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 250 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners amp; McKesson Corporation, we remain in an investment and growth mode. This means we are open-minded to how we get the work done – now is the perfect time to talk to us!

Our Current Solutions

Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care, reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment.

OncoHealth offers Oncology Insights Pro, an analytic software solution that enables health plans to use data and analytics to improve oncology programs. Using real world data, our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape.

OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018, the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies, offer utilization management and formulary advice, and development training for staff.

OncoHealth's latest offering is Iris, a digital telehealth platform that delivers personalized, oncology-specific support to navigate the physical symptoms and emotional challenges caused by cancer and cancer treatment. Powered by technology, staffed 24X7, and delivered with empathy, Iris allows patients to connect with trained oncology experts and receive personalized, oncology-specific telehealth support.

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