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Sarah Jenkins
Remote Physician Reviewer jobs in the United States
Job type
Min. salary, $/year
Level
Healthcare organizations across the United States are expanding their clinical review teams, creating 467 new openings for a physician reviewer. This remote position blends medical expertise with insurance and compliance knowledge, requiring physicians to assess case files, treatment plans, and claims objectively. With demand rising nationwide, companies are actively looking to hire a physician reviewer who can deliver accurate, timely assessments from anywhere in the country.
Successful candidates typically hold an active medical license and board certification, paired with strong analytical and communication skills needed to interpret complex clinical data. Employers favor professionals experienced in utilization review, case management, or quality assurance, along with comfort using electronic health record systems and virtual collaboration tools. Attention to detail, sound ethical judgment, and the ability to work independently remain essential traits for anyone pursuing physician reviewer positions today.
Remote work for a physician reviewer typically involves flexible scheduling, secure digital case platforms, and collaboration with multidisciplinary teams across different time zones. The United States continues to see strong demand for remote physician reviewer jobs, driven by the growth of telemedicine, insurance auditing, and value-based care initiatives. This shift lets physicians maintain meaningful clinical impact while enjoying the flexibility of working from home, regardless of state or city.
If you're ready to bring your clinical expertise to a flexible, high-impact career, now is the time to explore physician reviewer vacancies available through Global Work AI. Discover opportunities that match your experience and start making a difference in patient care from wherever you are.
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.
remote, United States$55k – $87k/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)MedOne, L.C
Evaluate and interpret clinical guidelines for specialty medication prior authorizations and appeals. Conduct clinical consultations with healthcare providers and patients, and perform scientific literature evaluations to support decision-making.
remote, United StatesFull TimeJunior (<2 years)
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.
remote, WY, United States$70k – $90k/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)
UnitedHealth Group
Conduct coverage reviews based on member plan benefits and coverage review policies, rendering coverage determinations. Document clinical review findings and engage in peer-to-peer discussions with providers.
remote, United States$249k – $373k/yrFull TimeDirector
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)
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)Emperion
Conduct independent, evidence-based file reviews of patient records and related documentation. Provide objective, high-quality reports within specified turnaround timelines while maintaining compliance with URAC, HIPAA, and internal quality standards.
remote, United StatesPart TimeEntry with DegreeAcentra 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)
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.
remote, United States$224k – $313k/yrFull TimeDirector
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)
Prolific Academic Ltd
Complete expert registration and medical-credential verification through Prolific’s onboarding process. If invited, complete an assessment to establish suitability for projects.
remote, United States$262k/yrFull TimeJunior (<2 years)Prolific Academic Ltd
Complete expert registration and medical-credential verification through Prolific’s onboarding process. If qualified, apply experience in utilization review, utilization management, or physician clinical review to paid research and AI-related tasks.
remote, United States$262k/yrFull TimeJunior (<2 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)
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.
remote, IA, United States$77k – $97k/yrFull TimeMiddle (2-4 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
R1 RCM
Review payor peer-to-peer cases for authorization denials, evaluating documentation for admission status and procedures. Advise clients on request appropriateness based on documentation and engage with payor medical directors.
remote, United States$150k – $199k/yrFull TimeMiddle (2-4 years)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.
remote, United StatesPart 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)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)
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.
remote, United StatesPart TimeSenior (5+ 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)
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.
remote, OH, United States$78k – $85k/yrFull TimeMiddle (2-4 years)
HURC
Provide clinical leadership and mentorship to the Physician Advisor team while maintaining an active production workload. Oversee utilization review and medical necessity cases, conduct quality audits, and monitor key performance indicators.
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 in the area of Infectious Disease. Maintain proper credentialing and ensure timely delivery of assessments and reports.
remote, IN, United StatesFull TimeSenior (5+ years)Mindrift
Evaluate clinical EHR vignettes for AI evaluation, scoring clinical reasoning quality, checking vignette accuracy, and writing rationales. Participate in independent blind reads and physician adjudication to ensure clinical complexity is addressed.
remote, United States$141k/yrPart TimeJunior (<2 years)Mindrift
Evaluate clinical EHR vignettes for AI evaluation, scoring clinical reasoning quality, checking vignette accuracy, and writing rationales. Participate in independent blind reads and physician adjudication to ensure clinical complexity is addressed.
remote, United States$141k/yrPart TimeJunior (<2 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
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. Maintain proper credentialing and compliance with state licenses and certifications.
remote, United StatesFull TimeSenior (5+ 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)10,000,000+ more jobs available!
