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Weekday Medical Necessity Reviewer Jobs (NOW HIRING)

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

This role is responsible for reviewing medical records, evaluating the medical necessity of requested services using established clinical guidelines, collaborating with physicians and healthcare ...

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Weekday Medical Necessity Reviewer information

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How much do weekday medical necessity reviewer jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for weekday medical necessity 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 the difference between Weekday Medical Necessity Reviewer vs Medical Claims Processor?

AspectWeekday Medical Necessity ReviewerMedical Claims Processor
CredentialsTypically requires healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires administrative or insurance processing training, with some roles needing basic healthcare knowledge
Work EnvironmentHealthcare facilities, insurance companies, or remote settings reviewing medical necessity casesInsurance companies, healthcare offices, or remote data entry environments processing claims
Industry UsageCommonly used in health insurance and managed care organizationsWidely used across insurance providers and healthcare billing departments

While both roles involve working within the healthcare and insurance sectors, the Weekday Medical Necessity Reviewer focuses on evaluating the medical necessity of treatments, whereas the Medical Claims Processor handles the administrative processing of insurance claims. Understanding these differences helps job seekers identify the right career path based on their skills and interests.

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What are the most commonly searched types of Medical Necessity Reviewer jobs?

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Weekday Medical Necessity Reviewer jobs near you

Clinical Care Reviewer

Integrated Resources INC

Philadelphia, PA

Full-time

Re-posted yesterday

Job description

Company Description

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Clinical Care Reviewer UM
Job Summary
The primary purpose of the job is to:
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the nurse's discretion to pend requests for additional information and/or request clarification. The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed. The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application.

Qualifications

Complete Description: 3 or more years experience in a related clinical setting.

Case management and utilization review experience preferred 

Registered Nurse
Excellent oral and written communication skills.
Ability to identify problems and recommend solutions.
Self-directed/Ability to work independently.
Excellent decision making skills.
Excellent time management skills, prioritizing work and meeting timelines.
Ability to advocate for member/member family needs.
Dedicated to meeting the expectations and requirements of internal and external customers.
Obtains continuing education required to maintain professional licensure.
Ability to achieve required performance results on all audits and Inter Rater Reliability (Peer to Peer).

Additional Information

Riya Khem

Life Science Recruiter 

Integrated Resources, Inc.

IT Life Sciences Allied Healthcare CRO

Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I

DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549



Integrated Resources logo

About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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