Clinical Reviewer - Healthcare QA & Compliance
$28.37 - $32 per hourAcentra Health, LLC
Acentra Health, LLC is seeking a Clinical Reviewer in the United States. The position involves utilizing clinical expertise to assess medical appropriateness during beneficiary interactions while meeting quality assurance standards. Responsibilities include ensuring review accuracy, managing workloads, and acting as a liaison for provider concerns. Successful candidates will hold an active clinical license and demonstrate strong communication and critical thinking abilities. The role offers a pay range of $28.37 to $32.00 per hour and provides various employee benefits. #J-18808-Ljbffr
$32 - $37 per hour
A leading healthcare provider in New York is looking for a qualified individual to fill a role that requires a Bachelor's degree in healthcare. Candidates should have at least 5 years of clinical experience, particularly in inpatient settings, and knowledge of the ACS NSQIP...SuggestedHourly pay$60 per hour
Greenlife Healthcare Staffing is seeking a meticulous RN Clinical Reviewer in Jericho or Albany, NY. This full-time, temp-to-hire position offers a competitive rate of $60 per hour and requires a strong OB/maternal health background, along with quality improvement skills...SuggestedHourly payFull timeTemporary work- The Clinical Documentation Review Specialist plays a crucial role in ensuring the... ...improve documentation, ensuring compliance with regulatory... ...documentation data outcomes for QA improvements.* Ensure documentation... ...with physicians and healthcare providers to clarify...SuggestedFull timeLive outLocal areaFlexible hours
$83.1k - $120.36k
The Clinical Peer Reviewer (Phyiscal Therapy) Utilization Management (UM) plays a critical role in consulting on medical necessity in the context... ...across lines of business while maintaining regulatory compliance and supporting optimal functional outcomes for members. The...SuggestedWork experience placement$80.6k - $145k
Clinical Data Reviewer - Internal Medicine (US, CAN, UK Only) Syneos Health is a leading fully-integrated life sciences services organization... ...and employment of its employees. The Company is committed to compliance with the Americans with Disabilities Act, including the...SuggestedContract workInterim roleRemote workFlexible hours- ...diagnosis and treatment procedures into codes while ensuring compliance with coding standards. The ideal candidate will have experience... ...requires a detail-oriented professional who can work collaboratively with healthcare providers. #J-18808-Ljbffr Miller County Hospital
- ...work from home and ensure the accuracy and compliance of billing claims. The coder will handle various work queues including Charge Review and Follow Up while maintaining industry... ...of experience in coding or billing in healthcare. Relevant certifications are required....Remote jobFull timeWork from home
- 6AM City, LLC is seeking a QA Report Reviewer - Level 1, primarily remote but requires some in-office training. The role focuses on reviewing... ...and content, and effective communication with clients and healthcare professionals. Candidates should possess strong writing abilities...Remote jobWork at office
- ...All Jobs Clinical Appeals Reviewer (Licensed Healthcare Professional) Clinical Appeals Reviewer (Licensed Healthcare Professional) • Fully Remote • United... ...ethics, and organizational standards. Ensure compliance with company policies, procedures, and guidelines, including...Full timeContract workPart timeFor contractorsWork at officeLocal areaRemote workNight shift
- ...payment audits of DRG coding and clinical documentation. The ideal... ...recoverable claims by reviewing medical records and other documentation... ...and judgment to ensure compliance with medical policy, medical... ...or fraudulent activities by healthcare providers through prepayment...Live inRemote workWork from homeMonday to Friday
$50 - $60 per hour
...We are looking for a Clinical Reviewer to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate... ...work Responsibilities Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs Evaluate the quality...Hourly payFull timeContract workPart timeRemote work- ...A healthcare organization is seeking a Nurse Practitioner for a remote 1099 contractor role, requiring... ...state licenses. The responsibilities include reviewing patient data, developing care plans, and communicating with clinical staff to enhance patient outcomes. Candidates...For contractorsRemote workFlexible hours
- ...A leading healthcare service provider in the United States is looking for a Clinical Appeals Reviewer. This fully remote position involves reviewing appeal cases and making independent decisions based on medical evidence. Candidates must be licensed healthcare professionals...Remote work
$86k
...- USD86000 per year What’s the job? Code inpatient records using ICD-10-CM and ICD-10-PCS Review detailed clinical documentation for accuracy and completeness Ensure compliance with CMS and regulatory standards Communicate with providers to clarify and improve documentation...Remote work- ...outpatient coding within the Health Information Management department. Candidates will review medical records and assign accurate diagnostic and procedure codes, ensuring compliance and data integrity. Required qualifications include a high school diploma, coding certification...Remote work
$54k - $66.5k
...establish and optimize billing workflows from day one Identify and resolve claim denials, underpayments, and payer disputes Ensure compliance with payer-specific billing requirements and OON reimbursement rules Maintain accurate documentation and support auditing...Permanent employmentFull timeContract workWork at officeImmediate startRemote work- A healthcare analytics firm is seeking a highly experienced DRG Clinical Physician Reviewer to join its remote clinical review team. This role emphasizes clinical validation and utilization review to ensure accurate DRG assignment and support healthcare quality. Candidates...Remote job
$32 - $37 per hour
...3 Months with possible ongoing extension Pay Range: $32 to $37/Hour Job Description and Requirements: Bachelor’s degree in healthcare (clinical nursing or medicine) (required). Min 5 yrs clinical exp (required - inpatient preferred). Previous exp w/ American College of...- A healthcare organization seeks a Clinical Peer Reviewer (Physical Therapy) to ensure evidence-based utilization of PT services while adhering to regulations. The role involves reviewing complex cases, collaborating with medical directors, and analyzing PT utilization...
$50 per hour
...Overview RN Clinical Reviewer / IDR - Remote (#25310C) Location: Remote Employment Type: Full-time Hourly Rate: $50/hr Position Overview Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a remote position at a non-...Hourly payFull timeWork at officeRemote workFlexible hours- ...and ICD-10 codes. Certification from AAPC or AHIMA is required. Responsibilities include ensuring compliance, accurate data entry, and communicating effectively with clinical and administrative teams. Knowledge in various specialties and coding guidelines is essential to...Remote work
- ...leading health system in the United States is seeking a dedicated coding specialist to review clinical documentation and assign ICD-10-CM and ICD-10-PCS codes for billing and compliance. The ideal candidate will have an Associate or Bachelor's degree in Health...Full timeRemote work
- ...A healthcare technology company is looking for a Clinical Reviewer to evaluate AI chatbots. This role requires fluency in English and a medical degree either completed or in progress. You will tackle complex healthcare problems to improve the chatbot's performance, ensuring...Hourly payRemote workFlexible hours
$60 per hour
...About the Job RN Clinical Reviewer - Jericho or Albany, NY (#25332) Location: Jericho orAlbany, NY Employment Type: Full-time... ...hospital experience. Experience in an acute or ambulatory care healthcare facility reviewing charts for the purpose of quality...Hourly payFull timeTemporary workWork at office- ...candidates have a bachelor's degree and 5-7 years of experience in healthcare administrative support, along with proficiency in MS Office.... ...meetings, managing sensitive information, and ensuring compliance with medical policies. A supportive workplace valuing diversity...Full time
$30.6 - $31.17 per hour
...About Us We're Maimonides Health, Brooklyn's largest healthcare system, serving over 250,000 patients each year through the system... ...children's hospital and only pediatric trauma center. Maimonides' clinical programs rank among the best in the country for patient...$50 per hour
...A leading healthcare staffing firm is seeking an experienced RN Clinical Reviewer to work remotely. You'll conduct detailed medical-legal reviews and appeals while maintaining high accuracy and integrity. Key qualifications include a New York State RN license and at least...Remote work- St. Elizabeth HealthCare in Crestview Hills, Kentucky is seeking a Patient Service Representative... ...handle patient information and ensure compliance with revenue cycle operations. This... ...insurance details, and supporting clinical staff. A minimum of a High School Diploma...
$130k - $135k
...A healthcare organization is seeking a Team Lead in Chronic Care Management to assist the Clinical Manager with chart reviews and onboarding. The role involves providing ongoing education, participating in committees, and ensuring staff resources. Candidates must have...Remote work- ...A healthcare consultancy is seeking experienced Dermatologists licensed in New Jersey to conduct thorough reviews of clinical cases as independent clinical reviewers. This remote telework role allows for flexible scheduling as a 1099 contractor. Candidates should possess...For contractorsRemote workFlexible hours
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