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Sarah Jenkins
Remote Clinical Reviewer jobs in the United States
Job type
Min. salary, $/year
Level
Healthcare organizations across the United States are expanding their compliance and utilization review teams, creating a steady stream of remote clinical reviewer jobs for qualified professionals. With 479 open positions currently available, this is an excellent time for experienced reviewers to explore new opportunities that offer flexibility and career growth. Employers nationwide are actively seeking skilled reviewers who can balance medical expertise with regulatory knowledge.
Successful candidates typically bring strong medical backgrounds, often as registered nurses or allied health professionals, combined with sharp analytical skills for reviewing medical records and determining medical necessity. Familiarity with utilization management guidelines, InterQual or MCG criteria, and electronic health record systems is highly valued. Strong written communication, attention to detail, and the ability to work independently are essential traits, especially since many clinical reviewer vacancies require remote collaboration across multidisciplinary teams.
Remote work has become the norm for utilization review roles, allowing healthcare professionals throughout the USA to contribute to case audits, appeals, and quality assurance processes without relocating. Insurers, hospitals, and third-party review agencies are increasingly investing in remote infrastructure, reflecting strong regional demand for flexible oversight talent. This shift has opened doors for professionals in smaller markets to access national-level clinical reviewer positions.
If you're ready to take the next step in your healthcare career, explore current clinical reviewer openings through Global Work AI and connect with employers eager to hire a clinical reviewer who is dedicated and detail-oriented. Discover how your expertise can make an impact from anywhere in the country.
CareSource
Process medical necessity reviews for behavioral health services, assist with discharge planning, and coordinate care for members. Engage with medical directors for clinical expertise, maintain knowledge of regulations, and refer quality issues to Quality Improvement.
remote, MA, United States$75k – $121k/yrFull TimeMiddle (2-4 years)
Centene Corporation
Analyze prior authorization requests for medical necessity and appropriate care levels. Collaborate with healthcare providers and teams to ensure timely service reviews. Document and maintain clinical information in health management systems, ensuring compliance with regulations.
remote, TX, United States$54k – $98k/yrFull TimeJunior (<2 years)CareSource
Process medical necessity reviews for healthcare service authorization, assist with discharge planning, and coordinate care for members. Engage with medical directors for clinical expertise, monitor healthcare service delivery, and refer quality issues to Quality Improvement.
remote, MA, United States$75k – $121k/yrFull TimeMiddle (2-4 years)
HJ Staffing
Conduct Peer-to-Peer (P2P) reviews with treating physicians regarding authorization requests. Analyze clinical documentation and evaluate medical necessity and level of care. Apply CMS Medicare Advantage requirements and clinical criteria. Document P2P discussions and maintain HIPAA compliance.
remote, United StatesFull TimeLead / Manager
Mindrift
Evaluate clinical EHR vignettes for accuracy and completeness, assess clinical reasoning quality, and score benchmark items based on established criteria. Conduct independent blind reads and participate in physician adjudication to ensure quality and correctness of clinical cases.
remote, United States$101k/yrPart TimeJunior (<2 years)
Oscar Health
Conduct medical reviews to determine appropriateness of inpatient, outpatient, and pharmacy services. Document decisions in workflow tools, ensuring clarity for members. Engage in peer-to-peer discussions with providers to clarify clinical information and explain review outcomes.
remote, United States$275k/yrFull TimeSenior (5+ years)
BlueCross BlueShield of South Carolina
Perform medical reviews using clinical information and established guidelines. Document decisions and provide support for medical claims and utilization practices. Educate staff on medical reviews and participate in quality control activities.
remote, United StatesFull TimeJunior (<2 years)
Dane Street, LLC
Conduct comprehensive reviews of dental records, clinical examinations, diagnostic imaging, and treatment plans. Evaluate medical necessity and appropriateness of dental services, prepare clinical summaries, and respond to client inquiries.
remote, TX, United StatesFull TimeSenior (5+ years)
Devoted Health
Perform first-level clinical reviews of dental claims and pre-treatment estimates, ensuring compliance with clinical guidelines. Evaluate radiographs and treatment records, document findings in claims systems, and apply ADA CDT coding.
remote, United States$58k – $75k/yrFull TimeSenior (5+ years)
MICHIGAN PEER REVIEW ORGANIZATION
Conduct objective peer reviews of clinical cases, determining medical necessity and quality of care. Ensure decisions align with current standards of practice and submit reviews using provided IT systems in a timely manner.
remote, United StatesFull TimeSenior (5+ years)
Second Wave Delivery Systems
Review inpatient records for Patient Safety Indicators, mortality cases, and CMS Core Measures to identify documentation and coding opportunities. Recommend coding changes and manage physician queries to ensure accurate documentation.
remote, Las Vegas, NV, United States$95k – $120k/yrFull TimeSenior (5+ years)
Gainwell Technologies LLC
Coordinate and perform appeal-related duties, including analyzing and responding to provider appeals. Review documentation to ensure all aspects of the appeal are addressed accurately. Prepare case files and summaries for hearings, and participate in virtual and on-site hearings.
remote, United States$69k – $99k/yrFull TimeSenior (5+ years)
Amerihealth Caritas
The After-Hours BH UM Reviewer conducts medical necessity reviews for urgent coverage requests, coordinating behavioral health care management services. They evaluate provider requests for inpatient and outpatient services, ensuring compliance with medical management guidelines.
remote, United StatesFull TimeMiddle (2-4 years)
WellSky
Review acute and post-acute authorization requests and medical records for medical necessity. Manage medical necessity denials from notification to resolution, ensuring compliance with clinical guidelines.
remote, United StatesFull TimeMiddle (2-4 years)
Acentra Health, LLC
Review medical records against criteria to determine appropriateness, ensuring accuracy and timeliness. Assess and manage daily workload, collaborating with supervisors on quality monitoring and improvement plans. Serve as a liaison for providers and address customer service issues.
remote, United States$57k – $71k/yrFull TimeMiddle (2-4 years)
MedReview
Lead complex clinical validation reviews and provide final determinations on disputed findings. Manage physician-level appeals and conduct peer-to-peer discussions. Ensure compliance with CMS regulations and support quality assurance activities.
remote, United States$240k – $250k/yrFull TimeSenior (5+ years)
Virginia Information Technologies Agency
Review and develop mortality case summaries for individuals receiving DBHDS services, focusing on medical records and related documents. Analyze sequences of events leading to deaths and identify contributing factors.
remote, WY, United States$70k – $91k/yrFull TimeJunior (<2 years)
Syneos Health
Review clinical data for accuracy and compliance with regulatory standards. Collaborate with cross-functional teams to ensure data integrity and quality. Prepare reports and documentation to support clinical trials and regulatory submissions.
remote, United States$81k/yrFull TimeJunior (<2 years)Acentra Health, LLC
Review medical records against criteria to determine appropriateness. Ensure accuracy and timeliness of reviews, manage daily workload, and monitor quality. Serve as a resource for nurse reviewers and liaise with providers for customer service issues.
remote, United States$57k – $79k/yrFull TimeJunior (<2 years)Dane Street, LLC
Evaluate medical records, provide clinical summaries, engage in peer communications, and respond to client inquiries. Conduct thorough reviews of clinical cases in Reproductive Endocrinology/Infertility. Maintain proper credentialing and ensure timely delivery of assessments and reports.
remote, United StatesFull TimeSenior (5+ years)
AltaMed
Review authorization requests from various health plans, approving them per delegation responsibilities. Process denials using standard language and post recommendations in the authorization platform. Identify high-risk populations and refer them to case management programs.
remote, Montebello, CA, United States$249k – $311k/yrFull TimeJunior (<2 years)
ChenMed
Conduct utilization management reviews for assigned territories, establishing 2-3 cases daily across multiple markets. Attend health plan and local team calls, and participate in weekly PCP and SNF meetings. Advise other physician reviewers and engage in process and quality improvement initiatives.
remote, United States$205k – $293k/yrFull TimeJunior (<2 years)
MRIoA
Conduct independent Utilization Reviews as a Board-Certified Clinical Psychologist. Adhere to HIPAA regulations and company policies regarding patient confidentiality and security. Engage in peer-to-peer conversations during daytime hours as needed.
remote, MN, United StatesPart TimeSenior (5+ years)
Slingshot AI
Review anonymized conversations with Ash to assess its handling of key moments in mental health support. Provide clinical judgment on what Ash should do, potential pitfalls, and reasoning behind decisions.
remote, United States$202k – $282k/yrPart TimeLead / Manager
RediMinds, Inc
Review incoming case files for completeness and accuracy, validate system-generated summaries, quality-check clinicians’ written reviews, and perform final quality assurance on determination letters.
remote, United StatesFull TimeJunior (<2 years)24-Mag
Review inpatient cases for clinical quality and appropriateness of care, ensuring documentation accuracy. Apply senior hospitalist judgement to complex scenarios and maintain high standards of accuracy.
remote, New York, NY, United States$141k – $202k/yrFull TimeSenior (5+ years)
Elsevier
Review AI-generated content on dental and head/neck anatomy, oral pathology, and other dental topics. Apply structured evaluation metrics to assess accuracy and clinical relevance. Provide expert feedback to enhance educational value for dental hygiene learners.
remote, United States$111k/yrPart TimeJunior (<2 years)Elsevier
Review AI-generated content on surgical anatomy, instrumentation, sterile technique, and patient safety. Rate content for accuracy and completeness, providing expert commentary to enhance educational materials.
remote, United States$111k/yrPart TimeJunior (<2 years)Elsevier
Evaluate AI-generated content on cardiopulmonary anatomy, patient assessment, airway management, and respiratory pharmacology. Review critical care management content for neonatal, pediatric, and adult patients.
remote, United States$111k/yrPart TimeJunior (<2 years)
Osmosis
Collaborate with multidisciplinary teams to create and curate content on emerging medical technologies. Review and assess the impact of technologies on medical practice and patient care. Provide feedback throughout the content development cycle and ensure content accuracy.
remote, United States$91k – $111k/yrPart TimeJunior (<2 years)Osmosis
Collaborate with multidisciplinary teams to create and curate content on emerging medical technologies. Review and assess the impact of technologies on medical practice and patient care. Provide feedback throughout the content development cycle and ensure content accuracy.
remote, United States$91k – $111k/yrPart TimeJunior (<2 years)Osmosis
Collaborate with multidisciplinary teams to create and curate content on emerging medical technologies. Review and assess the impact of technologies on medical practice and patient care. Provide feedback throughout the content development cycle and ensure content accuracy.
remote, United States$91k – $111k/yrPart TimeJunior (<2 years)ChenMed
Oversee Utilization Management (UM) cases, establishing 2-3 cases daily across assigned markets. Attend health plan and local calls, and participate in weekly PCP and SNF meetings. Advise other physician reviewers and engage in process and quality improvement initiatives.
remote, United States$205k – $293k/yrFull TimeJunior (<2 years)
AtWork
Serve as a primary clinical reviewer for the ECR process, certifying assigned cases. Review assessments and medical records, develop clinical recommendations, and document rationales. Evaluate complex pediatric and adolescent cases, ensuring timely completion of reviews within 48 hours.
remote, AZ, United StatesFull TimeJunior (<2 years)
Wellbe Senior Medical
Conduct clinical documentation audits, evaluate medical records for compliance, and identify documentation risks. Deliver peer-level education to improve documentation practices and escalate complex cases to leadership.
remote, United StatesFull TimeMiddle (2-4 years)Dane Street, LLC
Evaluate medical records, provide clinical summaries, engage in peer communications, and respond to client inquiries. Conduct thorough reviews of clinical cases to ensure high-quality healthcare assessments.
remote, United StatesFull TimeSenior (5+ years)
COMAGINE HEALTH
Conduct clinical reviews for medical necessity, appropriateness, and quality of healthcare services. Evaluate service requests against established clinical criteria and collaborate with clinical teams and physician consultants.
remote, IA, United StatesFull TimeSenior (5+ years)Dane Street, LLC
Conduct comprehensive reviews of medical records, speech-language evaluations, and treatment plans. Prepare clinical summaries and provide evidence-based advisory opinions on speech, language, communication, cognitive-communication, voice, fluency, and swallowing disorders.
remote, PA, United StatesFull TimeSenior (5+ years)Gainwell Technologies LLC
Perform clinical reviews of medical records to assess medical necessity and appropriateness of care. Document review decisions and rationale, determine approvals, and process consultant decisions.
remote, United States$78k – $88k/yrFull TimeSenior (5+ years)Dane Street, LLC
Conduct comprehensive reviews of medical records, therapy documentation, and treatment plans. Prepare clinical summaries and provide evidence-based advisory opinions on speech-language pathology services. Evaluate clinical documentation and assess medical necessity and appropriateness of services.
remote, PA, United StatesFull TimeSenior (5+ years)10,000,000+ more jobs available!
