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Remote Clinical Reviewer Jobs in Raleigh, NC (NOW HIRING)

IQVIA

Director, Remote Research Clinicians

Durham, NC · Remote

Drive advancement of technology-enabled clinical trial solutions, including workflow automation ... Review quality metrics, issue trends, audit findings, and operational performance indicators to ...

IQVIA

Director, Remote Research Clinicians

Durham, NC · Remote

Drive advancement of technology-enabled clinical trial solutions, including workflow automation ... Review quality metrics, issue trends, audit findings, and operational performance indicators to ...

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All JobsClinical Reviewer JobsRemote Clinical Reviewer JobsRemote Clinical Reviewer Jobs in Raleigh, NC

Remote Clinical Reviewer information

See Raleigh, NC salary details

$23

$34

$45

How much do remote clinical reviewer jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for remote clinical reviewer in Raleigh, NC is $34.91, according to ZipRecruiter salary data. Most workers in this role earn between $30.38 and $39.23 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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Cities near Raleigh, NC with the most Remote Clinical Reviewer job openings:

Remote Clinical Reviewer jobs near you
Infographic showing various Remote Clinical Reviewer job openings in Raleigh, NC as of August 2026, with employment types broken down into 3% As Needed, 72% Full Time, 17% Part Time, and 8% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $72,617 per year, or $34.9 per hour.

Dental Consultant, Independent Contractor

Constellation Quality Health

Raleigh, NC • Remote

$125/hr

Contractor

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Dental Consultant, Independent Contractor

Remote

Who We Are

Constellation Quality Health is a non-profit health care quality consultancy and QIO-like Entity certified by Centers for Medicare and Medicaid Services (CMS) founded by physicians in 1983. Headquartered in North Carolinas Research Triangle, we offer an array of quality improvement, clinical review, audit, technical, and consulting services and solutions to improve care delivery, system performance, and patient outcomes.

What Youll Do

The Dental Consultant supports Constellations payment integrity work, both directly and under contract with our partners. This position is responsible for conducting detailed reviews of clinical records to determine appropriateness of treatment, timelines and fact chronology, determination of reasonable and necessary treatment modality, causation, and medical necessity. This includes assessing consistency between diagnosis, procedures, and clinical documentation. The Dental Consultant works collaboratively with program staff to provide expert opinions on care provided to patients and develops formal, professionally written summaries of those opinions based on evidence and accepted practice standards as derived from a review of the supporting documentation.

We Expect You To:

  • Utilize best practices to assess dental documentation to determine causation, appropriateness of treatment, and determine medical necessity.
  • Review clinical documentation for reasonable and necessary treatment modalities including assessment of consistency between diagnosis, procedures, and other treatments.
  • Document expert opinion of clinical findings, assessment of care, and utilization of practice standards in a professionally written, formal summary report.
  • Respond to and/or attend hearings as required which may include some travel.

This position is contingent upon work assigned by the customer and works remotely on an as needed basis.

Our requirement for this role:

  • Licensed Dentist (DDS or DMD) in good standing
  • Minimum 3-5 years of experience in performing expert clinical review of treatment records including review of radiographs, procedure reports, treatment notes, and other records in support of causation
  • Demonstrated ability to communicate complex clinical information to diverse audiences.
  • Strong written, verbal, visual, and interpersonal communication skills.
  • Experience developing formal, professionally written reports which may be used during litigation.
  • Ability to manage multiple projects simultaneously and meet deadlines in a fast-paced environment.
  • Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, Outlook, Teams, and SharePoint) for documentation, reporting, data management, and administrative functions.

Compensation & Contract Terms

  • Hourly rate: From $125.00, per hour
  • This engagement is contingent upon contract award, satisfactory performance and mutual agreement.
  • The selected consultant will operate as an independent contractor and will not be considered an employee. The contractor will be responsible for their own taxes, insurance, benefits, and business expenses unless otherwise specified in a written agreement.
  • The selected consultant agrees to maintain and provide current certificates of coverage for professional liability insurance ($1M /$1M) and cyber liability insurance ($1M /$1M)

Constellation Quality Health is committed to equal opportunity and nondiscrimination in contracting opportunities. We do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, gender identity, national origin, medical condition, disability, veteran status, or any other basis protected by law.

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