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Remote Clinical Reviewer Jobs in Rochester, NY (NOW HIRING)

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · Remote

$60 - $65/hr

While this is a remote position, candidates must reside in or be willing to relocate to one of the ... Engage in the Utilization Review process for assigned cases every month * Respond to clinical ...

Athena

Remote Psychotherapist

Rochester, NY · Remote

$50K - $100K/yr

Clinical Supervision is provided by experienced Licensed Clinicians * Free CEU Credits for LMSWs ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

Rochester Regional Health

Coder - Inpatient

Rochester, NY · On-site +1

$21.50 - $26/hr

SUMMARY Review clinical documentation and diagnostic results to extract data and apply appropriate ... Riedman- Remote SCHEDULE: Day shift ATTRIBUTES * Abides by the Standards of Ethical Coding as set ...

Deloitte

System Test and Validation Lead

Rochester, NY · On-site +1

... or clinical * Experience leading validation deliverables for GxP systems, including IQ/OQ/PQ ... Experience supporting periodic review programs for validated systems and associated CAPA triggers

Deloitte

System Test and Validation Lead

Rochester, NY · On-site +1

... or clinical * Experience leading validation deliverables for GxP systems, including IQ/OQ/PQ ... Experience supporting periodic review programs for validated systems and associated CAPA triggers

Deloitte

System Test and Validation Lead

Rochester, NY · On-site +1

... or clinical * Experience leading validation deliverables for GxP systems, including IQ/OQ/PQ ... Experience supporting periodic review programs for validated systems and associated CAPA triggers

Deloitte

Epic Denials Management Operator

Rochester, NY · Remote

$17.75 - $23.75/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 ...

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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 5, 2026, the average hourly pay for remote clinical reviewer in Rochester, NY is $35.44, according to ZipRecruiter salary data. Most workers in this role earn between $30.82 and $39.86 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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What are popular job titles related to Remote Clinical Reviewer jobs in Rochester, NY?

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

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The top searched job categories for Remote Clinical Reviewer jobs in Rochester, NY are:

What cities near Rochester, NY are hiring for Remote Clinical Reviewer jobs?

Cities near Rochester, NY with the most Remote Clinical Reviewer job openings:

Remote Clinical Reviewer jobs near you
Infographic showing various Remote Clinical Reviewer job openings in Rochester, NY as of August 2026, with employment types broken down into 82% Full Time, 9% Part Time, and 9% Contract. Highlights an 9% Hybrid, and 91% Remote job distribution, with an average salary of $73,705 per year, or $35.4 per hour.

Clinical DRG Denial Specialist - Riedman - Remote, Health Information Management (Full-Time, Days)

Rochester Regional Health

Rochester, NY • Remote

$37.50 - $43.25/hr

Full-time

This job post has expired 2 days ago. Applications are no longer accepted.

Rochester Regional Health rating

7.3

Company rating: 7.3 out of 10

Based on 221 frontline employees who took The Breakroom Quiz

305th of 898 rated healthcare providers

Job description

Job Title: Clinical DRG Denial Specialist - Riedman - Remote, Health Information Management (Full-Time, Days)
Department: Health Information Management
Location: Riedman - Remote
Status: Full-Time
Schedule: M-F, 7:00 AM - 3:30 PM
SUMMARY:
The Clinical DRG Denials Specialist applies clinical knowledge, coding principles, payer policy interpretation, and documentation review to support appropriate reimbursement and regulatory compliance and works to protect organizational reimbursement by ensuring the accurate review, appeal, and resolution of DRG-related payer denials. Additionally, the position proactively works to identify documentation and coding risks before claim submission to reduce avoidable denials and strengthen revenue integrity. Through analysis of denial trends and appeal outcomes, the role helps improve processes and support denial prevention strategies across the revenue cycle.
RESPONSIBILITIES:
• Ensures accurate and timely resolution of DRG-related payer denials and audit activity in order to protect reimbursement and minimize avoidable revenue loss.
• Produces well-supported and compliant appeal outcomes by applying clinical, coding, and payer policy knowledge to disputed DRG determinations.
• Maintains adherence to contractual, regulatory, and documentation requirements across denial, appeal, and pre-bill review activities to support compliance and payment integrity.
• Strengthens revenue integrity by identifying and addressing documentation, coding, and medical necessity risks before claim submission.
• Improves denial prevention performance through analysis of payer trends, denial patterns, and appeal outcomes, leading to responsive strategies and process enhancements.
• Ensures denial-related information, requirements, and case status are consistently maintained to support accurate tracking, reconciliation, and operational visibility.
• Promotes effective, standardized denial and appeal practices that support efficient workflows and consistent organizational response to payer challenges.
• Applies specialized clinical and coding expertise to support accurate DRG assignment, documentation integrity, and sustainable reimbursement outcomes across the revenue cycle.
REQUIRED QUALIFICATIONS:
  • Degree in Nursing
  • NYS Registered Nurse Licensure

PREFERRED QUALIFICATIONS:
  • Knowledge of Epic preferred
  • Proficient in Microsoft Office applications preferred
  • Practical experience with computerized encoding and grouping software preferred
  • Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist certification (CCS) preferred.
  • BSN preferred.

EDUCATION:
AS: Health Information Management (Required)
LICENSES / CERTIFICATIONS:
PHYSICAL REQUIREMENTS:
S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.
PAY RANGE:
$37.50 - $43.25
CITY:
Rochester
POSTAL CODE:
14617
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.

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