1:00 PM - 2:00 PM
Senior Product Manager Interview
Sarah Jenkins
Healthcare organizations across the country are expanding their compliance and quality teams, and 500+ remote medical reviewer jobs are now open for skilled professionals ready to make an impact. This role offers the flexibility of remote work while contributing to critical patient safety and documentation standards. Demand for qualified medical reviewers continues to grow as the industry prioritizes accuracy and regulatory compliance nationwide.
The most successful candidates bring strong clinical knowledge, attention to detail, and the ability to interpret complex medical records with precision. Familiarity with coding standards, utilization review processes, and regulatory guidelines is essential, along with excellent written communication skills for documenting findings clearly. Employers seeking to hire a medical reviewer often value analytical thinking, sound judgment, and the capacity to work independently while meeting strict deadlines in a fast-paced healthcare environment.
Remote work has become the standard arrangement for many medical reviewer positions in the USA, allowing professionals to collaborate with healthcare systems, insurers, and legal teams from anywhere in the country. This shift reflects a broader trend toward flexible staffing models in healthcare administration, with organizations increasingly relying on virtual talent to manage growing caseloads. The outlook for this profession remains strong, driven by ongoing regulatory updates and expanding telehealth services.
If you are ready to advance your career, explore current medical reviewer vacancies through Global Work AI and find the opportunity that matches your expertise. Our platform connects dedicated professionals with organizations seeking reliable, detail-oriented talent. Take the next step today and discover how rewarding remote medical reviewer positions can be for your future.

CareSource
Process medical necessity reviews for healthcare service authorizations, including inpatient and outpatient procedures. Coordinate care and assist with discharge planning activities, engaging with care partners. Monitor healthcare service delivery and refer quality issues to Quality Improvement.

CareSource
Process medical necessity reviews for healthcare service authorizations, 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.

CareSource
Review medical records for audit activities and make payment decisions on claims. Analyze moderately complicated claims based on coding guidelines, refer suspected fraud to SIU, and prepare audit summaries for Medical Director review.

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.

Capitol Bridge, LLC.
Review arbitration determination letters against quality standards, document findings, and provide feedback to arbitrators. Perform quality reviews of letters, assess documentation, and ensure compliance with policies. Identify quality trends and participate in calibration reviews.

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.

Peraton
Conduct medical record reviews and apply clinical judgment to claim payment decisions. Perform research on medical claims data to identify issues and support fraud investigations.

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.

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.

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.

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.

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.

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.

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.

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.

Amerihealth Caritas
Evaluate medical necessity for inpatient and outpatient services, ensuring compliance with clinical guidelines and regulations. Review provider requests, gather medical documentation, and make determinations based on clinical criteria.

Capitol Bridge, LLC.
Review and evaluate Workers’ Compensation Medicare Set-Aside (WCMSA) proposals, ensuring compliance with CMS guidelines. Determine future medical costs related to WC injuries and recommend WCMSA amounts to CMS. Ensure documentation requirements are met and implement CMS policy.

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.

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.

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.

Peraton
Conduct medical record reviews and apply clinical judgment to claim payment decisions. Perform research on medical claims data to identify issues and support fraud investigations.

Humana
Conduct inpatient medical necessity reviews based on national guidelines and regulations. Analyze complex hospital cases and deliver utilization management determinations. Communicate with external providers to obtain clinical information and discuss review outcomes.

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.

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.

SCAN Health Insurance
Review and analyze complex healthcare claims from a medical perspective. Conduct audits of medical claims, identify documentation needs, and interpret CMS guidelines.

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.

Peraton
Conduct medical record reviews and apply clinical judgment to claim payment decisions. Perform research on medical claims data to identify issues and support fraud investigations.

ePathUSA
Perform complex medical record and claim reviews for Medicare Part A and B, making coverage determinations based on policies and guidelines. Evaluate AI-assisted processes for compliance and support Program Integrity reviews to detect fraud, waste, and abuse.

HealthMinds Consulting Private Limited
Lead the identification and substantiation of promotional claims, ensuring compliance with regulatory standards. Manage the MLR workflow, including submission and approval processes, while mentoring junior reviewers.

J29, Inc
Perform automated and complex reviews of Medicare Fee-for-Service claims, assessing payments according to Recovery Audit Contractors guidelines. Document findings, participate in dispute resolution, support quality assurance through audits, and maintain compliance with CMS standards.

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.

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.
Emperion
Conduct independent, evidence-based file reviews of patient records and documentation. Provide objective, high-quality reports within specified turnaround timelines. Ensure compliance with URAC, HIPAA, and internal quality standards while maintaining clinical integrity.
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.

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.

Rainmakers Strategic Solutions
Review sponsor-submitted prior authorization (PA) and step therapy (ST) criteria for compliance with CMS guidance. Evaluate PA criteria fields for consistency with FDA-approved labeling and treatment guidelines.

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.

CoventBridge Integrity Systems
Conduct clinical reviews of medical records for fraud investigations and program integrity initiatives. Analyze claims history and provider files to detect fraudulent billing practices.

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.

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.
10,000,000+ more jobs available!