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Remote Medical Reviewer Jobs (NOW HIRING)

Community Health Network

Medical Reviewer

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Medical Reviewer. Primary Responsibilities: * Under the general direction of the Vice President of Clinical Affairs ...

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited ... Flexible, remote contract opportunity. * Set your own schedule and case volume. * Collaborate with ...

Apply Early

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited ... Flexible, remote contract opportunity. * Set your own schedule and case volume. * Collaborate with ...

Apply Early

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited ... Flexible, remote contract opportunity. * Set your own schedule and case volume. * Collaborate with ...

Apply Early

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited ... Flexible, remote contract opportunity. * Set your own schedule and case volume. * Collaborate with ...

Apply Early

Empower AI

Medical Reviewer III (Medicare/DRG)

Medical Review Specialist III (Medicare DRG) Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation.

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...

Empower AI

Medical Reviewer III (Medicare/DME)

Medical Review Specialist III As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...

US Tech Solutions

Medical Reviewer LPN #

Medical Claims Reviewer Duration: 3+ Months Contract (Possible extension) Onsite 1-2 weeks, then will work remote. Will be required to come onsite as needed for meetings and training. Typical day ...

InGenesis

RN / Medical Reviewer / Remote

RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review Employment Type : Full Time City : Columbia State : SC Pay Range : InGenesis is ...

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How much do remote medical reviewer jobs pay per hour?

As of Jul 2, 2026, the average hourly pay for remote medical reviewer in the United States is $42.06, according to ZipRecruiter salary data. Most workers in this role earn between $22.84 and $54.09 per hour, depending on experience, location, and employer.

What is a Remote Medical Reviewer job?

A Remote Medical Reviewer evaluates medical records, claims, or cases to ensure accuracy, compliance, and appropriate medical decision-making. They typically work for insurance companies, healthcare organizations, or third-party review agencies. This role involves analyzing documentation, applying clinical guidelines, and providing recommendations based on medical expertise. It requires a background in healthcare, such as nursing or medicine, along with strong analytical and communication skills. The job is performed remotely, allowing flexibility while maintaining high standards of medical review.

What are the key skills and qualifications needed to thrive in the Remote Medical Reviewer position, and why are they important?

A Remote Medical Reviewer requires a strong background in healthcare, such as a nursing or pharmaceutical degree, along with in-depth knowledge of clinical guidelines and regulatory standards. Familiarity with electronic medical record (EMR) systems, coding software, and industry certifications like RHIA or CCS is often necessary. Exceptional attention to detail, analytical thinking, and clear written communication are vital soft skills for this role. These competencies ensure accurate and timely medical review decisions that impact patient care and regulatory compliance.

What are some common challenges faced by Remote Medical Reviewers and how can they be addressed?

Remote Medical Reviewers often encounter challenges such as reviewing complex cases with limited background information and keeping up with frequent updates to medical regulations and insurance policies. Staying organized, participating in continuing education, and leveraging robust digital communication tools can help you overcome these obstacles. You'll also need to be self-motivated and comfortable working independently, as remote teams often collaborate primarily through virtual meetings and secure documentation platforms. Embracing strong time management practices and regularly connecting with colleagues for case discussions can greatly enhance your job performance and satisfaction.

More about Remote Medical Reviewer jobs
What cities are hiring for Remote Medical Reviewer jobs? Cities with the most Remote Medical Reviewer job openings:
What are the most commonly searched types of Medical Reviewer jobs? The most popular types of Medical Reviewer jobs are:
What states have the most Remote Medical Reviewer jobs? States with the most job openings for Remote Medical Reviewer jobs include:
What job categories do people searching Remote Medical Reviewer jobs look for? The top searched job categories for Remote Medical Reviewer jobs are:
Remote Medical Reviewer jobs near you
Infographic showing various Remote Medical Reviewer job openings in the United States as of June 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 37% Physical, 3% Hybrid, and 60% Remote job distribution, with an average salary of $87,476 per year, or $42.1 per hour.
Medical Reviewer

Medical Reviewer

Community Health Network

Remote

Other

Medical, Dental, Vision, Life, Retirement

Posted 9 days ago

Community Health Network rating

7.6

Company rating: 7.6 out of 10

Based on 224 frontline employees who took The Breakroom Quiz

189th of 877 rated healthcare providers

Job description

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Medical Reviewer.
Primary Responsibilities:

  • Under the general direction of the Vice President of Clinical Affairs, performs medical case review of services subject to approval under the Connecticut Medical Assistance Program (CMAP).
  • Participates and contributes actively in medical matters related to utilization management, case management, peer review, quality improvement and other processes requiring medical/clinical leadership and consultation.
  • Responds to inquiries from providers, internal stakeholders, and Department of Social Services as necessary.
  • Serves as a resource to CHNCT clinical staff.
  • Provides recommendations for improving care delivery and health outcomes for CMAP enrollees.
  • Participates in activities specific to contractual requirements such as Fair Hearings, etc.
Tasks Performed:
  • Appropriately documents case review findings, actions, and outcomes in keeping with established policies.
  • Collaborates with clinical staff to implement clinical and quality management programs and initiatives.
  • Interacts with providers and vendors regarding clinical care and services for CMAP enrollees.
  • Actively participates and contributes in medical review team meetings; participates in design and development of care programs and quality improvement initiatives as requested.
Essential Functions:
  • Engages in telephonic case review and discussion with providers.
  • Proactively shares resources, information and guidelines related to quality, cost-effective health care delivery.
  • Shares best practices with other Medical Reviewers, CHNCT clinical staff.
  • Applies performance data to guide interactions and inform discussions with stakeholders.
  • Maintains a high level of productivity; adheres to ASO contract standards regarding timeliness of reviews and appeals.
  • Consistently meets plan interrater reliability guidelines.
  • Required to attend Medical Reviewer Staff Meetings via phone or in person unless vacation, illness or other extenuating circumstances that prevents the Medical Reviewer to attend these meetings.
  • Required to be available for all training/retraining sessions via phone or in person unless vacation, illness or other extenuating circumstances that prevents the Medical Reviewer to attend these meetings. Note: training and retraining sessions may vary from year to year depending on assessment and need.
  • Required to attend all mandatory training provided by DSS.
  • Must comply with completing all company required trainings.
Desired Education: Medical School
Desired Degree: Medical Doctor or Doctor of Osteopathy
Desired Major: Primary care specialty
Desired Job Experience: Minimum 2 years as a Medical Reviewer or physician consultant in a managed care company preferred. Experience in Utilization Management, Case and Disease Management, preferably with Medicaid populations. Clinical experience in managing a range o1 pathologies and populations and up-to-date knowledge of evidence-based medical guidelines and accepted standards of care for managing the treatments, procedures, conditions, and diseases under review by CHNCT.
Other Qualifications: M.D. or D.O. current, non-restricted Connecticut license andBoard certification. Flexible and able to adapt to altered work processes, technologies, and directives.
Certifications Required: Physician; Surgeon
CHNCT Offers Great Benefits:
  • Medical, dental and vision coverage options
  • Flexible spending and health savings accounts
  • Group term life insurance
  • A 401(k) plan with company-match and immediate vesting
  • Voluntary accidental injury coverage
  • Tuition reimbursement and continuing education opportunities
  • A generous paid-leave bank and company holidays
  • Wellness program

We are dedicated to having a workplace where everyone feels valued, respected, and empowered to succeed. We embrace a wide range of perspectives and backgrounds, ensuring fair treatment and opportunities for all employees. We value our team's rich array of experiences and viewpoints, which contribute to our innovative and collaborative environment.
We are committed to providing an inclusive and accessible interview process. If you require a reasonable accommodation for your interview due to a disability. Please contact us in advance if you need an accommodation.

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