UNKNOWN

FEED

In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense.

Netsmart Technologies Inc

Coding & OASIS Reviewer (PRN)

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YEAR

Contributors may: Evaluate clinical EHR vignettes paired with a question, a proposed answer, and a distractor "trap" answer across diagnosis and treatment tasks, spanning cardiovascular, nervous, hematologic, respiratory, digestive, urinary, reproductive, musculoskeletal, and integumentary systems; Score the clinical reasoning quality of benchmark items: vignette accuracy and completeness, whether the vignette gives the answer away, answer correctness and gradeability, and trap quality; Check whether the reasoning chain reaches the answer from vignette facts alone, correct reasoning traces, and write short rationales. Practising or retired physicians welcome; Broad, multi-system diagnostic and treatment experience (internal, family, emergency, or hospital medicine); Strong clinical reasoning: differential diagnosis, next-step management, and application of evidence-based guidelines; Prior experience in medical AI evaluation, clinical content or exam-question review, or medical annotation/QA (a plus); Strong written English (C1+).

Mindrift

Physician Reviewer (MD/DO) - Medical AI Evaluation

Workable

As an integral part of the Physician Review Unit within HMM (Health and Medical management), the physician reviewer reports to the Medical director and works with a team of actively practicing board certified physicians from a variety of specialties while collaborating with and providing clinical support across the company. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

Blue Cross and Blue Shield of Massachusetts Inc

Physician Reviewer

Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but not limited to surgical procedures, Medicare Part B medications, Long Term Services and Supports (LTSS), and Home Health (HH). Communicates results of reviews verbally, in the medical record, and through official written notification to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements.

Sagility

RN Utilization Management Reviewer

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Dane Street is seeking experienced, Board-Certified or Board-Eligible Occupational Medicine Physicians licensed in Washington to join our growing panel of independent physician reviewers. As a Physician Reviewer, you will evaluate medical records, prepare concise clinical summaries, and provide independent medical opinions in response to specific questions posed by our clients.

Dane Street

Occupational Medicine Physician Reviewer (Remote | Washington Licensed)

In this role, you will leverage your clinical expertise to conduct comprehensive medical record reviews and provide objective, evidence-based opinions on cases involving musculoskeletal injuries, chronic pain conditions, rehabilitation services, functional impairment, and treatment planning. Dane Street is seeking experienced, Board-Certified Physical Medicine & Rehabilitation (PM&R) physicians licensed in Connecticut to join our growing panel of independent physician reviewers.

Physical Medicine & Rehabilitation Physician Reviewer (Remote) - Connecticut Lic

In this role, you will apply your clinical expertise to conduct comprehensive medical record reviews and provide objective, evidence-based opinions on cases involving spinal conditions, injuries, treatments, and surgical interventions. Dane Street is seeking experienced Board-Certified Orthopedic Spine Surgeons licensed in Tennessee to join our growing panel of independent physician reviewers.

Orthopedic Spine Surgeon - Medical Reviewer (TN)

In this role, you will leverage your clinical expertise to conduct comprehensive medical record reviews and provide objective, evidence-based opinions on cases involving musculoskeletal injuries, chronic pain conditions, rehabilitation services, functional impairment, and treatment planning. Dane Street is seeking experienced, Board-Certified Physical Medicine & Rehabilitation (PM&R) physicians licensed in Michigan to join our growing panel of independent physician reviewers.

Physical Medicine & Rehabilitation Physician Reviewer (Remote) - Michigan

In this role, you will apply your clinical expertise to conduct comprehensive medical record reviews and provide objective, evidence-based opinions on work-related injuries, illnesses, disability assessments, fitness-for-duty evaluations, and occupational health matters. Dane Street is seeking experienced Occupational Medicine Physicians licensed in Washington to join our growing panel of independent physician reviewers.

Occupational Medicine Reviewer (WA)

Dane Street is seeking experienced Orthopedic Surgeons licensed in Georgia to join our growing panel of independent physician reviewers. As a Physician Reviewer, you will evaluate medical records, prepare concise clinical summaries, and provide independent medical opinions in response to client-specific questions.

Physician Reviewer - Orthopedic Surgery (GA)

Collaborate with Provider Networks, Quality and Medical Management teams in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products.

HealthCare Partners, MSO

Medical Director - UM Reviewer (Part-Time)

The Applicant Manager

We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. The training will include a walkthrough of the Dane Street portal to ensure you are comfortable with the technology and to become familiar with the required formatting of the reports.

Registered Nurse Reviewer

FULL_TIME

Responsibilities may include additional research on medical claims data and other sources of information to identify problems, review sophisticated data model output, and utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information. Responsibilities: SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

Peraton drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted and highly differentiated national security solutions and technologies that keep people safe and secure. Peraton serves as a valued partner to essential government agencies across the intelligence, space, cyber, defense, civilian, health, and state and local markets. Every day, our employees do the can’t be done, solving the most daunting challenges facing our customers.

Peraton

Nurse Reviewer – Medicaid

[AW]-iCims

Review assigned SSAT accommodation applications and supporting records, which may include IEPs, Section 504 plans, private-school documentation, psychoeducational evaluations, medical documentation, and other materials describing a student's testing needs. The contractor will review documentation, complete routine decisions within established authority, communicate with families and other stakeholders, maintain accurate system records, and elevate complex or higher-risk matters for guidance.

HOUR

TalentED Advisors

E3n -Fractional SSAT Reviewer

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Nurse Reviewer

The QR’s main area of responsibility will be to ensure that OASIS assessments are completed in accordance with CMS Regulatory Requirements and Conventions for completing OASIS-C (Chapter 3) in the OASIS-C Guidance Manual. The Quality Reviewer is a Registered Professional Nurse who will ensure the accuracy, completeness and integrity of documentation completed by the COC.

Americare Certified Special Services

Pediatric Quality Reviewer

RN Quality Reviewer ACF

RN Quality Reviewer - ACF

As an African American-owned and Veteran-owned company, ApTask offers a comprehensive suite of services, including staffing and recruitment solutions, managed services, IT consulting, and project management. ApTask is a leading global provider of workforce solutions and talent acquisition services, dedicated to shaping the future of work.

ApTask

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Your main task will be to evaluate medical records, provide clinical summaries, engage in peer communications, and answer specific questions posed by our clients. Your expertise is vital to helping us deliver high-quality healthcare assessments.

Clinical Reviewer Jobs in the United States

Coding & OASIS Reviewer (PRN) Netsmart Technologies Inc

Physician Reviewer (MD/DO) - Medical AI Evaluation Mindrift

Physician Reviewer Blue Cross and Blue Shield of Massachusetts Inc

RN Utilization Management Reviewer Sagility

Occupational Medicine Physician Reviewer (Remote | Washington Licensed) Dane Street

Physical Medicine & Rehabilitation Physician Reviewer (Remote) - Connecticut Lic Dane Street

Orthopedic Spine Surgeon - Medical Reviewer (TN) Dane Street

Physical Medicine & Rehabilitation Physician Reviewer (Remote) - Michigan Dane Street

Occupational Medicine Reviewer (WA) Dane Street

Physician Reviewer - Orthopedic Surgery (GA) Dane Street

Medical Director - UM Reviewer (Part-Time) HealthCare Partners, MSO

Registered Nurse Reviewer Dane Street

Nurse Reviewer – Medicaid Peraton

E3n -Fractional SSAT Reviewer TalentED Advisors

Nurse Reviewer Peraton

Pediatric Quality Reviewer Americare Certified Special Services

RN Quality Reviewer ACF Americare Certified Special Services

RN Quality Reviewer - ACF Americare Certified Special Services

Nurse Reviewer ApTask

Board Certified Disability Peer Physician Reviewer - Medical Oncology Dane Street

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