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Rn Clinical Reviewer Jobs (NOW HIRING)

NTT DATA Services

BPO Clinical Review Specialist

FL · On-site

$76K/yr

Clinical Reviewer Specialist (RN) Position Summary The Clinical Reviewer Specialist is responsible for performing clinical and medical necessity reviews to support the timely and accurate processing ...

HealthHelp

Nurse - Clinical Review

$65K - $75K/yr

Nurse - Clinical Review Performs utilization review of cases to determine if the request meets ... Remote Compensation Disclosure The base salary for this position is $65,000 [LVN/LPN], $75,000 [RN] ...

Pure Infusion

RN Clinical Review Specialist

Sandy, UT · On-site

As a Registered Nurse Clinical Review Specialist at Pure Healthcare, you are responsible for ensuring timely approval and renewal of patient care services to allow Pure Healthcare to meet patient ...

Aleracare

RN Clinical Review Specialist

Sandy, UT · On-site

As a Registered Nurse Clinical Review Specialist at Pure Healthcare, you are responsible for ensuring timely approval and renewal of patient care services to allow Pure Healthcare to meet patient ...

Comagine Health

$75K - $90K/yr

Clinical Reviewer - Portland, Oregon 5 days ago Requisition ID: 1126 Salary Range: $75,000.00 To $90,000.00 Annually Are you passionate about improving access to behavioral health services in the ...

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How much do rn clinical reviewer jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for rn 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 is an RN Clinical Reviewer?

RN Clinical Reviewers are registered nurses who evaluate medical records and clinical documentation to ensure compliance with healthcare regulations and standards. They review patient cases, analyze treatment plans, and determine the medical necessity of services provided. This role often involves working with insurance companies, healthcare providers, or hospitals to ensure accurate and appropriate care. RN Clinical Reviewers use their clinical expertise to assess the quality and efficiency of patient care, helping to improve healthcare outcomes and reduce unnecessary costs.

What are the key skills and qualifications needed to thrive as an RN Clinical Reviewer?

To thrive as an RN Clinical Reviewer, you need a current RN license, strong clinical judgment, and experience in healthcare settings, often supported by a BSN or higher degree. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory standards like CMS and HIPAA is typically required. Excellent analytical skills, attention to detail, and effective written and verbal communication set top performers apart. These skills ensure accurate clinical review, regulatory compliance, and clear communication with healthcare providers, which are vital for high-quality patient care and efficient case management.

What are some common challenges faced by RN Clinical Reviewers, and how can they be navigated successfully?

RN Clinical Reviewers often encounter challenges such as managing a high volume of case reviews within tight deadlines and staying current with evolving healthcare regulations and payer guidelines. To navigate these challenges, strong organizational skills, attention to detail, and effective communication with multidisciplinary teams are essential. Many reviewers also benefit from ongoing professional development and collaboration with peers to ensure consistent and accurate clinical assessments.

What is the difference between Rn Clinical Reviewer vs Rn Case Manager?

AspectRn Clinical ReviewerRn Case Manager
CredentialsRegistered Nurse (RN), often with certifications in case management or clinical reviewRegistered Nurse (RN), with case management certification often preferred
Work EnvironmentHealthcare organizations, insurance companies, or third-party review agenciesHospitals, clinics, insurance companies, or community health settings
Primary FocusReview medical records, ensure compliance, and evaluate care for appropriatenessCoordinate patient care, advocate for patients, and manage treatment plans
Common TasksClinical review, documentation, and compliance checksPatient assessments, care planning, and resource coordination

While both roles require RN credentials and involve patient care, Rn Clinical Reviewers focus on evaluating medical records and ensuring compliance, whereas Rn Case Managers coordinate patient care and advocate for treatment needs. The roles often overlap but serve different primary functions within healthcare organizations.

How to become a registered nurse clinical reviewer?

To become a registered nurse clinical reviewer, you typically need to hold an active registered nurse (RN) license, gain clinical experience in a healthcare setting, and develop knowledge of medical records and insurance processes. Additional certifications in case management or healthcare quality, along with strong analytical and communication skills, can enhance eligibility for this role.

How to become an RN clinical reviewer?

To become an RN clinical reviewer, one typically needs a valid registered nurse license and several years of clinical experience. Additional qualifications may include familiarity with medical records, coding, and documentation, as well as strong analytical skills; some employers also prefer certifications in case management or health information management.
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Rn Clinical Reviewer jobs near you
Infographic showing various Rn Clinical Reviewer job openings in the United States as of September 2026, with employment types broken down into 3% As Needed, 74% Full Time, 16% Part Time, and 7% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.

CLINICAL REVIEWER - MA - FULL TIME

Lakeland, FL • On-site

WATSON CLINIC LLP
Outpatient Health Care • 1 - 5K employees
Learn more about WATSON CLINIC LLPexternal

Full-time

Posted 28 days ago

Watson Clinic rating

6.6

Company rating: 6.6 out of 10

Based on 40 frontline employees who took The Breakroom Quiz

576th of 898 rated healthcare providers

Job description

Description

Summary/Objective

The Clinical Reviewer uses their medical knowledge to identify and address quality gaps and assist with the coordination of care for the Clinic's patients. This role produces, abstracts, and submits data, and works from portals, spreadsheets, and databases to support quality projects and Value Based Services contracts. Clinical Reviewers are responsible for contacting patients telephonically to schedule needed care or perform monitoring.

Essential Functions

  • Accurately abstracts data from Watson Clinic's EHR and hospital EHR to support quality initiatives and projects with both internal and external entities.
  • Accurately enter clinical data into payer portals, spreadsheets, and/or the database to track status of data abstraction projects and close care gaps.
  • Accurately utilizes Watson Clinic protocols, care coordination guidelines, and patient-specific provider treatment plans to: Ensure patients have access to clinic providers and needed appointments. Educate Watson Clinic patients on managing conditions/diseases. Promote patient self-management. Assist with coordinating health care services and site of care concerns, and communicate with physician-lead Care Teams.
  • Follow program guidelines to assist physicians with documentation of patient interactions in an electronic platform for risk adjustment coding purposes.
  • Works in a team environment with risk adjustment coders, RNs, and analysts to ensure providers are following proven processes to appropriately increase their quality ratings and HCC risk scores.
  • Maintains excellent communication skills with patients to promote adherence to each patient's specific provider treatment plan



Requirements

Required Education and Experience: High school diploma or GED. Completion of an accredited Medical Assistant program. Medical Assistant Certification must be obtained within 90 days of employment. Ability to use filters, attach documents, and work with a variety of Microsoft applications is required.

Preferred Education and Experience: Coding experience or certification, or some college is preferred. Experience and understanding of quality metrics in an outpatient clinic setting is highly preferred.

Additional Eligibility Qualifications: Ability and initiative to become familiar with industry and individual health plan incentive program quality measurement specifications related to group practices, e.g., National Committee for Quality Assurance (NCQA) Health Effectiveness Data Information Set (HEDIS).


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