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Remote Clinical Reviewer Jobs (NOW HIRING)

TEEMA

Clinical Quality Reviewer - REMOTE

$41 - $44/hr

CLINICAL QUALITY REVIEWER (RN or LCSW) Job ID: 87049 Location: USA- Remote in approved states Overview: We are partnering with a leading organization supporting a large-scale federal healthcare ...

TEEMA

RN Clinical Quality Reviewer

Phoenix, AZ · Remote

$40 - $43/hr

Job Summary RN Clinical Quality Reviewer TEEMA Full-time Remote | Phoenix, AZ, United States Overview: We are partnering with a leading organization supporting a large-scale federal healthcare ...

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How much do remote clinical reviewer jobs pay per hour?

As of Jun 30, 2026, the average hourly pay for remote clinical reviewer in the United States is $35.92, according to ZipRecruiter salary data. Most workers in this role earn between $31.25 and $40.38 per hour, depending on experience, location, and employer.

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 cities are hiring for Remote Clinical Reviewer jobs? Cities with the most Remote Clinical Reviewer job openings:
What states have the most Remote Clinical Reviewer jobs? States with the most job openings for Remote Clinical Reviewer jobs include:
What job categories do people searching Remote Clinical Reviewer jobs look for? The top searched job categories for Remote Clinical Reviewer jobs are:
Remote Clinical Reviewer jobs near you
Infographic showing various Remote Clinical Reviewer job openings in the United States as of June 2026, with employment types broken down into 68% Full Time, 21% Part Time, and 11% Contract. Highlights an 37% Physical, 3% Hybrid, and 60% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.
Clinical Reviewer - RN - PRN (Remote U.S.)

Clinical Reviewer - RN - PRN (Remote U.S.)

Acentra Health, LLC

Remote

Other

Medical, Retirement

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

Acentra Health rating

6.3

Company rating: 6.3 out of 10

Based on 16 frontline employees who took The Breakroom Quiz

165th of 207 rated it services

Job description

Company Overview
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.
Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.
Job Summary and Responsibilities
Acentra Health is looking for a Clinical Reviewer - RN - PRN (Remote U.S.) to join our growing team.
Job Summary:

  • Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with NCQA, URAC, CMS, and other regulatory benchmarks, ensuring precision and compliance in medical record reviews.
Responsibilities:
  • Review and interpret patient records, comparing them against criteria to determine medical necessity and appropriateness of care; assess if the medical record documentation supports the need for services.
  • Initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for denial is described in sufficient detail in correspondence.
  • Abstract review-related data/information accurately and promptly using the appropriate means on an appropriate review tool.
  • Ensure accurate and timely submission of all administrative and review-related documents to the company.
  • Perform ongoing reassessment of the review process to identify improvement and/or change opportunities.
  • Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building, facilitating the review process.
  • Be responsible for attending training and scheduled meetings and maintaining and using current/updated information for review.
  • Maintain medical records confidentiality by properly using computer passwords, maintaining secured files, and adhering to HIPAA policies.
  • Utilize proper telephone etiquette and judicious use of other verbal and written communications, following company policies, procedures, and guidelines.
  • Actively cross-train to perform duties of other contracts within the company network to provide a flexible workforce to meet client/consumer needs.
  • Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
The above list of responsibilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary.
** Preferred availability is during business hours (8:00 AM-5:00 PM, Monday-Friday). We can be flexible with scheduling based on individual availability. Occasional weekend coverage may be requested as needed. **
Qualifications
Required Qualifications/Experience:
  • Active, unrestricted Registered Nurse (RN) License in South Carolina, or an RN compact state license.
  • Associate's, Bachelor's degree (or Diploma) in Nursing.
  • 2+ years of clinical experience in an acute OR med-surgical environment.
  • 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization.
  • 1+ years of knowledge of InterQual criteria.
  • Remote work experience.
Preferred Qualifications/Experience:
  • Knowledge of Utilization Review Accreditation Commission (URAC) standards.
  • Knowledge of Medicare (CMS) guidelines.
  • Medical Record Abstracting skills.
  • Clinical assessment and critical thinking skills.
  • Excellent verbal and written communication skills.
  • Ability to work in a team environment.
  • Flexibility and strong organizational skills.
  • Proficient in Microsoft Office and Internet/Web Navigation.

#LI-SD1
Why us?
We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.
We do this through our people.
You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.
Thank You!
We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!
~ The Acentra Health Talent Acquisition Team
Visit us at Acentra Health
EEO AA M/F/Vet/Disability
Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.
Benefits - PRN
This position includes access to select Acentra Health benefits and programs, such as participation in the Acentra Health 401(k) Plan with company match, access to wellness and employee discount programs, and Employee Assistance Program (EAP) resources.
Compensation
The pay range for this position is listed below.
"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."
Pay Range
USD $28.37 - USD $36.00 /Hr.

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