ZipRecruiter

Log In

2

Remote Clinical Reviewer Jobs in Springboro, OH (NOW HIRING)

Miamioh

Mental Health Clinician

Hamilton, OH · On-site +1

$62K/yr

Maintains clinical records and provides clinical documentation and communication with external ... Review of applicant materials will begin two weeks after posting and continue until filled.

Alto

Verification Pharmacist - FuzeRx

Sharonville, OH · On-site +1

$53.50 - $64.25/hr

... downstream clinical or dispensing review. Operating in a remote capacity, the Verification Pharmacist supports remote verification functions to maintain efficient, compliant, and high-quality ...

Deloitte

System Test and Validation Lead

Dayton, OH · 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

Dayton, OH · 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

Dayton, OH · 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

Dayton, OH · Remote

$17.50 - $23.25/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 ...

next page

Showing results 1-20

All JobsClinical Reviewer JobsRemote Clinical Reviewer JobsRemote Clinical Reviewer Jobs in Springboro, OH

Remote Clinical Reviewer information

See Springboro, OH salary details

$21

$31

$40

How much do remote clinical reviewer jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for remote clinical reviewer in Springboro, OH is $31.67, according to ZipRecruiter salary data. Most workers in this role earn between $27.55 and $35.62 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.

More about Remote Clinical Reviewer jobs

What are popular job titles related to Remote Clinical Reviewer jobs in Springboro, OH?

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

What cities near Springboro, OH are hiring for Remote Clinical Reviewer jobs?

Cities near Springboro, OH with the most Remote Clinical Reviewer job openings:

Remote Clinical Reviewer jobs near you
Infographic showing various Remote Clinical Reviewer job openings in Springboro, OH as of August 2026, with employment types broken down into 93% Full Time, and 7% Part Time. Highlights an 100% Remote job distribution, with an average salary of $65,871 per year, or $31.7 per hour.

Clinical Care Reviewer II - RN - IN MCD - IN or MSL Licensed

CareSource

Dayton, OH • On-site, Remote

$62K - $100K/yr

Full-time

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

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

210th of 315 rated insurance

Job description

Job Summary:
Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring the delivery of healthcare services.
Essential Functions:
  • Complete prospective, concurrent and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment
  • Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care
  • Engage with medical director when additional clinical expertise if needed
  • Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards
  • Identify and refer quality issues to Quality Improvement
  • Identify and refer appropriate members for Care Management
  • Provide guidance to non-clinical staff
  • Provide guidance and support to LPN clinical staff as appropriate
  • Attend medical advisement and State Hearing meetings, as requested
  • Assist Team Leader with special projects or research, as requested
  • Perform any other job related duties as requested.

Education and Experience:
  • Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required
  • Three (3) years clinical experience required
  • Med/surgical, emergency acute clinical care or home health experience preferred
  • Utilization Management/Utilization Review experience preferred
  • Medicaid/Medicare/Commercial experience preferred
Competencies, Knowledge and Skills:
  • Proficient data entry skills and ability to navigate clinical platforms successfully
  • Working knowledge of Microsoft Outlook, Word, and Excel
  • Effective oral and written communication skills
  • Ability to work independently and within a team environment
  • Attention to detail
  • Proper grammar usage and phone etiquette
  • Time management and prioritization skills
  • Customer service oriented
  • Decision making/problem solving skills
  • Strong organizational skills
  • Change resiliency
Licensure and Certification:
  • Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required
  • MCG Certification or must be obtained within six (6) months of hire required
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Travel is not typically required

Compensation Range:
$62,700.00 - $100,400.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Hourly
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-JM1
Brand=CareSource

What CareSource employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply