2,461 clinical review jobs at 923 companies in United States
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Clinical Review Coordinator (NEW)
Las Vegas, Nevada, United States
$60k-$83k/yr RemoteFull Time
2+ YOERN or LPN licensure, healthcare-related degree and clinical background preferred. Requires 2–4 years of Medicare clinical decision-making, medical review, utilization review, or claims review experience.
3d
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Clinical Review Clinician
Washington, District of Columbia, United States
$75k-$85k/yr OnsiteFull Time
3+ YOEMaster’s degree in social work, counseling, psychology, or related field; active DC independent clinical license; 3+ years SUD practice and 1+ year utilization review, management, and quality assurance experience.
Electronic Health Record (EHR)
2w
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Clinical Review Nurse - Novitas
United States or Alabama or Arkansas or Florida or Georgia or Idaho or Indiana or Iowa or Kansas or Kentucky or Louisiana or Mississippi or Nebraska or North Carolina or North Dakota or Ohio or Pennsylvania or South Carolina or Tennessee or Texas or Utah or West Virginia or Wisconsin or Wyoming
RemoteFull Time
2+ YOEActive unrestricted RN license, 2 years clinical experience, strong written/oral communication, clinical review and medical decision skills, and Microsoft Office proficiency.
Microsoft Office
3w
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PRN Clinical Review - Weekends
Oldsmar, Florida, United States
RemoteFull Time, Part Time
2+ YOECurrent LPN or RN, 2+ years home health intake/clinical review experience, knowledge of Medicare/CMS/COPs, strong clinical decision-making, EMR and Microsoft Office proficiency.
WellSky, Microsoft Outlook, Microsoft Teams, Microsoft Excel, EMR
2mo
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Clinical Review Pharmacist
Scottsdale or South Jordan
$116k-$120k/yr OnsiteFull Time
3+ YOE3+ years clinical pharmacy experience, Pharmacy B.S. or Pharm.D., strong documentation and communication skills; prior authorization, MTM, and workers' compensation managed care experience preferred.
2mo
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Clinical Utilization Review Specialist
United States
OnsiteFull Time
2+ YOEAssociate degree in nursing and 2–4 years of clinical experience in utilization review, case management, or acute care nursing. RN licensure required; CCM or ACM preferred.
case management software, Electronic Health Records (EHR)
2mo
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Clinical Review Specialist (Roseville)
Roseville, California, United States
$81k-$122k/yr OnsiteFull Time
2+ YOERN preferred; CPHQ or CPPS required; 2 years quality data abstraction; 3 years peer review/quality reporting preferred.
2mo
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Clinical Review Nurse - Prior Authorization
Pomona, California, United States
$62k-$94k/yr OnsiteFull Time
3+ YOEActive California LVN or RN license; 3-5+ years clinical UM review; prior authorization in managed care; knowledge of MCG criteria; EZCap experience preferred; California DMHC/CMS knowledge.
EZCap, MCG guidelines
1w
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PRN Clinical Review Nurse (RN)
United States
RemotePart Time
3+ YOEActive unrestricted RN license (compact preferred),3+ years clinical experience,2+ years utilization review/appeals experience,EMR and Epic proficiency,knowledge of payer guidelines,appeals writing and documentation skills.
EMR, Epic, InterQual, MCG
1w
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Manager, Clinical & Coding Review
Missouri or Michigan or Florida
$108k-$199k/yr RemoteFull Time
8+ YOE5+ MgmtAssociate's degree in health information management, nursing, or related; 8+ years complex medical claim review; 5+ years managerial experience; proficiency in ICD-10, MS-DRG/APR-DRG and clinical guidelines.
ICD-10-CM/PCS, MS-DRG, APR-DRG, DRG, Readmission, APC, EAPG
2mo
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Clinical Utilization Review Specialist
Franklin, Tennessee, United States
OnsiteFull Time
2+ YOEAssociate degree in nursing required, active RN licensure, 2+ years clinical experience in utilization review/case management/acute care, proficiency with EHR and case management software, strong communication and analytical skills.
case management software, EHR
2mo
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Clinical Review Specialist (31389)
Southlake, Texas, United States
$65k-$90k/hr OnsiteFull Time
5+ YOENursing degree or diploma with LVN or RN in good standing, 5+ years nursing experience, 1+ year case management/utilization review, knowledge of CPT/ICD-10 and payer guidelines, strong communication and documentation skills.
CPT, ICD-10
2w
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Clinical Review Nurse I/II/Sr/Lead
Indianapolis or Denison or Louisville or Cincinnati or Mason or Seven Hills or Grand Prairie or South Portland or East Syracuse or Atlanta or Latham or Miami or Tampa or Lake Success
$80k-$115k/yr RemoteFull Time
5+ YOEAS in nursing with minimum 5 years clinical experience or equivalent, current unrestricted RN license, BS in nursing preferred, Medicare home health and clinical review experience preferred.
2w
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Clinical Review Manager
Wichita, Kansas, United States
OnsiteFull Time
3+ YOEUnrestricted RN license, 3+ years home health experience preferred, knowledge of OASIS and Medicare Conditions of Participation, EMR proficiency, strong analytical and communication skills.
OASIS, Electronic Medical Records (EMR)
3w
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Clinical Review Specialist
Daytona Beach, Florida, United States
OnsiteFull Time
Bachelor's degree required; behavioral health and Medicaid/DCF/CARF auditing experience preferred. Knowledge of CARF, HIPAA, Medicaid, DCF/LSF standards. Valid Florida driver's license and background screening required.
1w
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Clinical Claim Review RN
Massachusetts, United States
$29-$52/hr RemoteFull Time
2+ YOEActive unrestricted Massachusetts RN or LPN license, high school diploma/GED or equivalent experience, 2+ years reviewing healthcare documentation, Microsoft Office proficiency, and valid driver's license.
Microsoft Word, Microsoft PowerPoint, Microsoft Excel, CPT-4, HCPCS, ICD-10
2mo
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Home Health Clinical Review Specialist
Orlando, Florida, United States
OnsiteFull Time
2+ YOECurrent LPN, 2+ years skilled home health/intake or care coordination experience, knowledge of Medicare/CMS guidelines, EMR (WellSky preferred) and Microsoft Office proficiency, strong clinical decision-making and phone skills.
EMR, WellSky, Microsoft Outlook, Microsoft Teams, Microsoft Excel
1mo
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Clinical Quality & Utilization Review Specialist
Austin, Texas, United States
OnsiteFull Time
3+ YOEBSN or doctoral APP required, unrestricted Texas RN license, 3+ years clinical nursing experience, 2+ years utilization management experience, peer review and quality improvement experience, proficiency with electronic health records and Microsoft Office.
Electronic Health Records, Microsoft Office Suite, PDSA, Lean, Six Sigma
1mo
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Clinical Quality & Utilization Review Specialist
Austin, Texas, United States
OnsiteFull Time
3+ YOEBSN or doctoral AP degree required, unrestricted Texas RN license, 3 years clinical experience, 2 years utilization management experience, proficiency with electronic health records and Microsoft Office, peer review and quality improvement experience.
Electronic Health Records, Microsoft Office Suite
1mo
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Quality Assurance Clinical Review Specialist (Pasadena)
Pasadena, California, United States
$28-$31/hr OnsiteFull Time
4+ YOEMaster's in social work/psychology or related, 4+ years EPSDT/Short Doyle Medi-Cal experience, knowledge of mental health regulations, clinical documentation and compliance expertise, ability to train staff and conduct chart reviews.
Welligent, DMH portal
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