Clinical Reviewer Jobs in the United States
US Tech Solutions, Inc.
$60
Canton, MA
The Clinical Reviewer, Inpatient RN provides timely, clinically appropriate and cost-effective utilization management and discharge planning activities for company’s members receiving services at her / his assigned facilities and may be required to float to provide coverage at unassigned facilities. Job Description: The Clinical Reviewer, Inpatient RN, is a licensed professional that is expected to function independently in her / his role and is responsible for managing a clinically complex caseload of members across one or more types of inpatient settings; acute, subacute, acute rehabilitation, LTAC, and others.
GreenLife Healthcare Staffing
$45 - $50
Jericho, NY
This role combines clinical expertise with analytical review, focusing on utilization reviews, quality data collection, and appeal-level determinations to support healthcare quality improvement initiatives. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.
GreenLife Healthcare Staffing
Jericho, NY
Greenlife Healthcare Staffing is seeking a meticulous Clinical Reviewer Proofer Registered Nursewho will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.
Texas Oncology
Ft Worth, Texas
Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. TheUS Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.
GreenLife Healthcare Staffing
Jericho, NY
Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills. Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York.
GreenLife Healthcare Staffing
Jericho, NY
Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills. Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York.
Greenlife Healthcare Staffing
$45 - $50
Jericho, New York
About Greenlife Healthcare Staffing:We are committed to our core values: integrity, honesty, and transparencyFinding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming. We understand that every situation is different and our approach reflects that: we value personalized interaction with job seekers and employers, our searches are customized not cookie-cutter and our results speak for themselves: Happy job seekers and employers who found the right professional match through our services.
Greenlife Healthcare Staffing
$45
Jericho, New York
About Greenlife Healthcare Staffing:We are committed to our core values: integrity, honesty, and transparencyFinding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming. Position Overview:Greenlife Healthcare Staffing is seeking a meticulous Clinical Reviewer Proofer Registered Nurse who will complete the full spectrum of activities related to Utilization or Quality reviews as assigned.
Greenlife Healthcare Staffing
$120000 - $124000
Jericho, NY
Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York. Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills.
Greenlife Healthcare Staffing
$45 - $50
Jericho, NY
This role combines clinical expertise with analytical review, focusing on utilization reviews, quality data collection, and appeal-level determinations to support healthcare quality improvement initiatives. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.
Greenlife Healthcare Staffing
Jericho, NY
Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York. Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills.
UnityPoint Health
Waukee, Iowa
US Tech Solutions, Inc.
$55 - $60
Canton, MA
We are seeking an experienced Inpatient RN Utilization Reviewer to independently manage a clinically complex inpatient caseload across multiple care settings, including acute, subacute, rehabilitation, and LTAC. The ideal candidate is a self-directed clinical professional with strong utilization management experience, sound judgment, and the ability to balance clinical decision-making with health plan business objectives.
Evolent
$32 - $37
Santa Fe, NM
Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.
Evolent
$68 - $73
Olympia, WA
LICENSE/CERTIFICATION: + Current, unrestricted state PA or RN/NP license in medicine or required specialty + If a PA, obtaining a passing score on a national certifying exam + Obtaining and maintaining required licenses, per business need + A clinical license, active and in good standing, in your home state is required OTHER SKILLS and ABILITIES: + Strong clinical, management, communication, and organizational skills. + Demonstrated leadership skills + Analytic skills + Energetic and curious with a passion for quality and value in health care + Required to pass skills proficiency test To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID.
The Cigna Group
$71100 - $118500
Bloomfield, CT
Evaluate telephone, fax, or web requests for authorization of coverage of molecular and genetic laboratory requests from physician offices; comparing requests against established clinical protocols; and authorizing coverage of services or referring requests for expert clinical review as appropriate. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._.
Acentra Health, LLC
$28.37 - $32
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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. Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
Acentra Health, LLC
$28.37 - $35
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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. Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
Acentra Health, LLC
$28.37 - $39.19
undefined, Arkansas
Hold an active, unrestricted Arkansas licensure in Social Work OR Counseling OR Psychology issued by the Arkansas Social Work Licensing Board OR Arkansas Board of Examiners in Counseling and Marriage & Family Therapy OR Arkansas Psychology Board in good standing, in one of the following: LCSW - Licensed Clinical Social Worker. 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.
Acentra Health, LLC
$28.37 - $33
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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. Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
Acentra Health, LLC
$28.37 - $39.19
undefined, Maine
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. 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.
Acentra Health, LLC
$28 - $32
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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. Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
Acentra Health, LLC
$28.37 - $39.19
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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. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.
Acentra Health, LLC
$34 - $38
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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. Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
Acentra Health, LLC
$28.37 - $35
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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. 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.
Acentra Health, LLC
$35 - $40
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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. Bachelor's degree (or higher level of education) from an accredited college or university in an Occupational Therapy program, 5+ years of direct clinical work experience.
Acentra Health, LLC
$28.37 - $39.19
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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. 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.
MetroHealth
Cleveland, OH
Minimum of 5 years as Clinical Documentation Integrity Specialist or; - CDIP or CCDS Certification with minimum of 3 years of CDI experience or; - CDI Second Level Reviewer with a strong understanding of disease processes, clinical indications and treatments, provider documentation requirements according to the rules of Medicare, Medicaid, and commercial payors, and a solid understanding of hospital acquired conditions (HAC's), patient safety indicators (PSI's) and mortality models. Qualifications: Required: Bachelor's degree in nursing or LPN, certified coder or Physician (MD / DO) with CDI experience in DRG validation or DRG downgrade activities, or any equivalent combination of education, training and experience in addition to experience noted below.
AmeriHealth Caritas
Philadelphia, PA
This role involves outreach to appellants or their representatives, obtaining and reviewing medical records, packaging pertinent information into a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full intent of the appeal. Skills & Abilities: Strong verbal and written communication, critical thinking, presentation, and the ability to manage and complete multiple high-priority tasks within designated timeframes.
Dane Street
Nashville, NY
We are currently seeking Board-Certified Physical Medicine and Rehabilitation providers with an active New York medical license and Workers’ Compensation Board Certification to conduct Utilization Reviews. We partner with highly qualified, actively practicing physicians to ensure high-quality, evidence-based clinical decisions that support better outcomes across the healthcare system.
Dane Street
Nashville, NY
We partner with highly qualified, actively practicing physicians to ensure high-quality, evidence-based clinical decisions that support better outcomes across the healthcare system. We are currently seeking Board-Certified Orthopedic Surgeons with an active New York medical license and Workers’ Compensation Board Certification to conduct Utilization Reviews.
Ivyhill Technologies LLC
$64000
Bethesda, MD
Collaborates with appointing center, case managers, product line nurses, providers, clinics, manage care support contractor liaison and other members of the healthcare team as needed to address any process issues or concerns, to ensure proper use of Direct Care system and civilian network resources, and to ensure that patients are booked at the right time, with the right provider, at the right place. Ivyhill is currently seeking to hire LPN Referral Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions’ premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health Network.
Ivyhill Technologies LLC
$47000
Bethesda, MD
Collaborates with appointing center, case managers, product line nurses, providers, clinics, manage care support contractor liaison and other members of the healthcare team as needed to ensure proper use of Direct Care system and civilian network resources, as well as to ensure that patients are booked at the right time, with the right provider, at the right place. Team Ivyhill is currently seeking to hire Referral Management (Non-Nurse) Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions’ premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health Network.
Alura Workforce Solutions
Rancho Cucamonga, CA
Assist Medical Directors in providing medical direction and guidance to the Health Services Department in the area of inpatient, outpatient pre-service authorizations, grievances, quality reviews and the coordination of care with external agencies, consultation on complex cases, and participation in Interdisciplinary Care Teams/case conferences. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell.
Alura Workforce Solutions
Los Angeles, CA
Assist Medical Directors in providing medical direction and guidance to the Health Services Department in the area of inpatient, outpatient pre-service authorizations, grievances, quality reviews and the coordination of care with external agencies, consultation on complex cases, and participation in Interdisciplinary Care Teams/case conferences. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell.
TEEMA
$25 - $29
Phoenix, AZ
Identifies and reports any potential quality or fraud issues to management, Quality Management, or Program Integrity as needed. Validates medical determinations through research of resources including regulatory manuals, computer files, and documentation.
Greenlife Healthcare Staffing
$57200
Syracuse, NY
Greenlife Healthcare Staffing is currently seeking a Dental Hygienist Reviewer to fill an opening with a Non-profit organization located in Upstate, New York. Completes all pre-review activities, including scheduling, notification, review of previous monitoring information, and other protocols as required.
Healthfirst
Remote, NY
Demonstrate the ability to be flexible when case load volume fluxes and when Leadership requests changes in case priorities to support our members//internal medical departments as needed. + Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases//caseload from multiple lines of businesses.
Broadway Ventures
Augusta, GA
Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), Required Education: Bachelor's degree Nursing, Graduate of accredited School of Nursing. Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations.
Qsource
Jackson, MS
Conduct independent reviews of adverse benefit determinations, medical necessity decisions, provider disputes, investigations, and audit findings issued by Medicaid managed care organizations. You focus solely on clinical review, while our internal teams handle all case intake, assembly, and administrative functions.
Maximus Federal & VES
$150 - $500
McLean, VA
For more information, please visit Maximus to learn more about our organization and how we support our government stakeholders and the population in receiving healthcare services. Maximus Federal is seeking a Board-Certified Dermatologist to join our Medical Consultant panel as an Expert Medical Reviewer to conduct medical judgment appeals.
Maximus Federal & VES
$150 - $500
McLean, VA
For more information, please visit Maximus to learn more about our organization and how we support our government stakeholders and the population in receiving healthcare services. Maximus Federal is seeking a Primary Care Physician to join our Medical Consultant panel as an Expert Medical Reviewer to conduct medical judgment appeals.
Broadway Ventures
San Antonio, TX
As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. The RN Senior Medical Reviewer provides advanced medical review expertise and supports oversight of the medical review process, focusing on complex services and quality assurance.
Maximus Federal & VES
McLean, VA
Maximus Federal is seeking a board-certified Oncologist (5+ years) MD/DO, to serve as a Medical Expert supporting the Social Security Administration Office of Hearings Operations. If you hold an active, unrestricted license and are interested in meaningful, flexible work beyond clinical practice, we’d love to connect.
Maximus Federal & VES
$150 - $400
McLean, VA
Description: The medical professional shall be a clinician expert in the treatment so the enrollees medical condition and knowledgeable about the proposed treatment though recent or current actual clinical experience treating patients with similar medical condition(s). We are currently looking for 100% Remote 1099 Independent Medical Reviewer with Pediatric Rehabilitation Medicine Experience.
CoventBridge Group
$65000 - $75000
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Advance knowledge of medical terminology and experience in the analysis and processing of Medicare claims, utilization review/ quality assurance procedures, ICD 10-CM and CPT coding, Medicare coverage guidelines and payment methodologies (i.e., Correct Coding Initiative, DRG's, Prospective Payment Systems and Ambulatory Surgical center), NCPCP and other types of prescription drug claims. CoventBridge Group is the global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs.
AdNet AccountNet, Inc.
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This role involves conducting independent medical documentation reviews, providing written medical assessments, and performing telehealth or in‑person evaluations to determine the impact of an individual's medical condition on job‑related functions. Workload varies based on case volume; typical tasks include documentation reviews (majority), telehealth assessments, and limited domestic travel for in‑person evaluations.
Visiting Nurse Service of New York d/b/a VNS Health
$93400 - $116800
New York, New York
Ensures Quality Improvement programs are aligned with CMS Triple Aim framework: improving the patient’s experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare. Develops forms, record abstracts, reports, and other tools used to implement concurrent and retrospective patient/member case review, including the design, testing and evaluation of the review methodology.
Managed Medical Review Organization
null, (Multiple States)
Managed Medical Review Organization (MMRO) is an established, URAC-accredited Independent Review Organization (IRO) that provides objective, evidence-based medical peer reviews nationwide. We are currently seeking Board-Certified Oncology Physicians to join our network of sub-contracted Physician Reviewers.
Managed Medical Review Organization
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We are currently seeking Board-Certified Pediatric Nephrology Physicians to join our network of sub-contracted Physician Reviewers. Managed Medical Review Organization (MMRO) is an established, URAC-accredited Independent Review Organization (IRO) that provides objective, evidence-based medical peer reviews nationwide.