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  1. Home
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  3. ›Medical Reviewer
‹ Remote Jobs

Remote Medical Reviewer jobs in the United States

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Aug 23, 2025

Medical Reviewer — Remote Opportunities Across the USA

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.

Frequently Asked
Questions

Everything you need to know about
finding your next role
  • What does a remote medical reviewer do?

    A remote medical reviewer evaluates clinical records, trial data, safety reports, or prior-authorization files from a home office and provides informed medical judgments that support healthcare, life sciences, or regulatory decisions. In the USA, this work often involves reviewing case details for accuracy, consistency, and risk while coordinating with nurses, pharmacists, data teams, or physicians through secure platforms. The role may also include documenting findings and escalating complex issues. If you are comparing remote openings, look for the type of review work involved and the level of specialty knowledge expected.
  • What qualifications are required for a medical reviewer role in the USA?

    Most employers in the USA look for a medical degree such as an MD, DO, MBBS, or equivalent international training, plus relevant clinical experience. Some medical reviewer jobs also favor residency background, board certification, or exposure to pharma, biotech, insurance, or health-plan settings. Strong English communication and comfort with electronic review systems are standard. Depending on the employer and scope of work, active licensure may matter, especially for roles tied to clinical decisions. Reviewing current listings helps clarify whether a specialty background is preferred.
  • What skills are needed for a medical reviewer in clinical, pharmacovigilance, or regulatory work?

    Success in a medical reviewer role depends on sharp clinical reasoning, careful documentation, and the ability to interpret evidence across protocols, adverse-event reports, and regulatory submissions. In pharmacovigilance, pattern recognition and signal assessment are especially valuable, while regulatory work often calls for familiarity with FDA expectations and GxP processes in the USA. Clear writing, attention to detail, and sound judgment under deadlines also matter. Because many teams are cross-functional, collaboration with safety, legal, or operations staff is just as important as technical expertise.
  • What are the main responsibilities of a medical reviewer in healthcare or life sciences?

    Typical duties include assessing patient charts, study data, safety narratives, medical necessity cases, or product complaints and then providing a documented clinical conclusion. In healthcare and life sciences organizations across the USA, a medical reviewer may help determine eligibility, confirm coding accuracy, evaluate adverse events, or support medical surveillance and regulatory response. The work often includes quality checks, escalation of high-risk findings, and written summaries for internal teams. Comparing openings by sector can help you see whether the focus is payer, pharma, CRO, or device-related work.
  • What should I expect from a remote medical reviewer job in terms of schedule, tools, and collaboration?

    Remote schedules are often steady weekday hours, though some teams in the USA offer flexible shifts, part-time arrangements, or deadline-driven workloads tied to case volume. Expect secure access to EHRs, review portals, document systems, video meetings, and sometimes specialized safety or claims software. Collaboration usually happens through email, chat, and virtual case conferences with physicians, pharmacists, quality staff, or study teams. Since confidentiality is central, employers may require a private workspace and reliable internet. It helps to compare tools and workflow expectations before moving ahead.
  • Is a medical license required for medical reviewer jobs in the USA?

    Not always. Some medical reviewer roles in the USA can be filled by licensed physicians, while others are designed for clinicians who have medical training but do not need active patient-facing practice. Requirements depend on the employer, the state, and whether the work involves formal clinical decision-making, chart review, or regulatory sign-off. In pharma, insurance, and research settings, an active license may be preferred or required for certain tasks. Checking current postings is the best way to confirm whether licensure, board status, or state authorization is part of the role.
  • What career growth opportunities are available for a medical reviewer?

    A medical reviewer can move into senior reviewer, medical director, safety physician, clinical operations, or regulatory leadership roles, especially in the USA where healthcare and life sciences employers value cross-functional experience. With time, professionals often specialize in pharmacovigilance, evidence review, claims policy, or device surveillance, or shift toward team management and strategy. Some also use the role as a bridge into consulting, medical affairs, or quality leadership. Growth tends to be strongest when you build expertise in a therapeutic area and track openings that match your long-term direction.

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500+ jobs found

  • CareSource

    CareSource

    Today

    Clinical care reviewer ii (massachusetts rn licensure required)

    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.

    remote, MA, United States
    $75k – $121k/yrFull TimeMiddle (2-4 years)
  • CareSource

    CareSource

    Today

    Clinical care reviewer ii (ohio rn licensure required)

    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.

    remote, OH, United States
    $63k – $100k/yrFull TimeMiddle (2-4 years)
  • CareSource

    CareSource

    Today

    Pi medical coding reviewer ii (cpc, rhit or rhia required)

    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.

    remote, United States
    $55k – $87k/yrFull TimeMiddle (2-4 years)
  • CareSource

    CareSource

    Today

    Clinical care reviewer ii - behavioral health

    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)
  • Capitol Bridge, LLC.

    Capitol Bridge, LLC.

    a day ago

    Peer reviewer (qa)

    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.

    remote, WY, United States
    $70k – $90k/yrFull TimeJunior (<2 years)
  • CareSource

    CareSource

    a day ago

    Rn clinical care reviewer - must have ma rn license direct um experience preferred!

    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)
  • Peraton

    Peraton

    2 days ago

    Medical review nurse- medicare

    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.

    remote, United States
    $51k – $82k/yrFull TimeJunior (<2 years)
  • HJ Staffing

    HJ Staffing

    4 days ago

    Physician advisor- peer-to-peer medical reviewer

    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 States
    Full TimeLead / Manager
  • Mindrift

    Mindrift

    5 days ago

    Physician reviewer (md/do) - medical ai evaluation

    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

    Oscar Health

    5 days ago

    Physician reviewer - utilization management

    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

    BlueCross BlueShield of South Carolina

    5 days ago

    Rn medical reviewer ii - palmetto gba-13

    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 States
    Full TimeJunior (<2 years)
  • MICHIGAN PEER REVIEW ORGANIZATION

    MICHIGAN PEER REVIEW ORGANIZATION

    5 days ago

    Peer reviewer - dentist - remote

    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 States
    Full TimeSenior (5+ years)
  • Second Wave Delivery Systems

    Second Wave Delivery Systems

    5 days ago

    Clinical documentation quality reviewer / cdi query writer

    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

    Gainwell Technologies LLC

    5 days ago

    Nurse reviewer appeals and hearing

    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)
  • Acentra Health, LLC

    Acentra Health, LLC

    6 days ago

    Clinical reviewer-sca

    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)
  • Amerihealth Caritas

    Amerihealth Caritas

    7 days ago

    Utilization management reviewer

    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.

    remote, United States
    Full TimeMiddle (2-4 years)
  • Capitol Bridge, LLC.

    Capitol Bridge, LLC.

    7 days ago

    Case reviewer ii

    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.

    remote, United States
    $70k/yrFull TimeJunior (<2 years)
  • MedReview

    MedReview

    7 days ago

    Senior physician reviewer

    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

    Virginia Information Technologies Agency

    7 days ago

    Clinical nurse reviewer

    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)
  • Acentra Health, LLC

    Acentra Health, LLC

    8 days ago

    Clinical reviewer-rn

    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)
  • Peraton

    Peraton

    8 days ago

    Medical review analyst - medicare

    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.

    remote, United States
    $66k – $106k/yrFull TimeSenior (5+ years)
  • Humana

    Humana

    8 days ago

    Medical director - inpatient review

    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.

    remote, United States
    $224k – $313k/yrFull TimeDirector
  • Dane Street, LLC

    Dane Street, LLC

    8 days ago

    Board certified physician reviewers - reproductive endocrinology/infertility

    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 States
    Full TimeSenior (5+ years)
  • AltaMed

    AltaMed

    12 days ago

    Physician reviewer

    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)
  • SCAN Health Insurance

    SCAN Health Insurance

    12 days ago

    Medical review nurse

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

    remote, CA, United States
    $79k – $113k/yrFull TimeMiddle (2-4 years)
  • ChenMed

    ChenMed

    12 days ago

    Licensed physician reviewer - remote - endocrinology

    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)
  • Peraton

    Peraton

    12 days ago

    Medical review analyst

    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.

    remote, United States
    $51k – $82k/yrFull TimeSenior (5+ years)
  • ePathUSA

    ePathUSA

    13 days ago

    Medical review nurse

    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.

    remote, IA, United States
    $77k – $97k/yrFull TimeMiddle (2-4 years)
  • HealthMinds Consulting Private Limited

    HealthMinds Consulting Private Limited

    14 days ago

    Senior medical content reviewer: promotional claims sme

    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.

    remote, United States
    Full TimeSenior (5+ years)
  • J29, Inc

    J29, Inc

    14 days ago

    Medical reviewer, coder - seasonal

    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.

    remote, United States
    $71k – $81k/yrPart TimeSenior (5+ years)
  • Slingshot AI

    Slingshot AI

    15 days ago

    Experienced clinician reviewer (remote uk/us)

    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

    RediMinds, Inc

    16 days ago

    Case review manager – independent reviews (iro/ur)

    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 States
    Full TimeJunior (<2 years)
  • Emperion

    Emperion

    19 days ago

    Board-certified physician for disability appeal reviews

    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.

    remote, United States
    Part TimeJunior (<2 years)
  • 2

    24-Mag

    20 days ago

    Remote | senior hospitalist clinical reviewer — $70–$100/hour

    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)
  • ChenMed

    ChenMed

    20 days ago

    Licensed physician reviewer - nephrologist

    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)
  • Rainmakers Strategic Solutions

    Rainmakers Strategic Solutions

    21 days ago

    Prn pharmacist reviewer – medicare part d formulary criteria review

    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.

    remote, United States
    Part TimeSenior (5+ years)
  • Dane Street, LLC

    Dane Street, LLC

    22 days ago

    Board certified internal medicine physician disability peer reviewer

    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 States
    Full TimeSenior (5+ years)
  • CoventBridge Integrity Systems

    CoventBridge Integrity Systems

    22 days ago

    Medicaid medical review rn (medical reviewer iii)

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

    remote, OH, United States
    $78k – $85k/yrFull TimeMiddle (2-4 years)
  • COMAGINE HEALTH

    COMAGINE HEALTH

    22 days ago

    Clinical reviewer registered nurse (rn) washington state.

    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 States
    Full TimeSenior (5+ years)
  • Gainwell Technologies LLC

    Gainwell Technologies LLC

    a month ago

    Nurse reviewer (registered nurse) - remote

    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)

10,000,000+ more jobs available!