Remote Physician Reviewer Jobs
Remote physician reviewer jobs are open across the U.S. at remote-first insurers, distributed utilization management firms, and health tech companies, with demand concentrated in managed care, workers' compensation, and independent review organizations. Employers hiring remotely right now include ChenMed, Dane Street, and Michigan Peer Review Organization. Find a role that fits below and apply directly.
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About Us
www.integritym.com
Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.
At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!
Position Summary
The Medical Clinical Review Consultant provides professional medical expertise in support of healthcare claim reviews by conducting independent clinical evaluations of claims and supporting documentation, including medical records, treatment plans, clinical notes, diagnostic testing, imaging, procedure documentation, and relevant claims data. The Consultant assesses medical necessity, clinical appropriateness, quality of care, and whether the documentation supports the services billed, and develops objective, well-supported clinical determinations in accordance with applicable Medicaid policies, coverage requirements, established clinical criteria, and generally accepted standards of medical practice.
Key Responsibilities
- Conduct independent clinical reviews of healthcare claims and supporting medical documentation.
- Review medical records, treatment plans, clinical notes, diagnostic testing, imaging, procedure documentation, and other relevant clinical information.
- Evaluate services for medical necessity, clinical appropriateness, and consistency with generally accepted standards of medical practice.
- Assess whether the medical documentation supports the services, procedures, diagnoses, and level of care billed.
- Apply applicable Medicaid policies, coverage requirements, clinical criteria, and review guidelines when developing determinations.
- Identify potentially unnecessary, excessive, duplicative, unsupported, or otherwise questionable services based on the clinical documentation.
- Develop clear, objective, and well-supported clinical determinations and document the rationale for review findings.
- Respond to requests for clarification or additional clinical analysis regarding completed reviews.
- Escalate complex clinical or policy questions as appropriate and participate in clinical discussions when needed.
- Maintain consistency, accuracy, and objectivity across assigned reviews.
- Meet established quality, productivity, and project timelines.
- Maintain the confidentiality and security of protected health information and comply with applicable HIPAA and data security requirements.
Requirements
Required Qualifications
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school.
- Current, active, and unrestricted license to practice medicine in at least one U.S. state or jurisdiction.
- Medical license must be in good standing, with no current restrictions, suspensions, or disciplinary limitations that would affect the ability to perform clinical reviews.
- Minimum of two (2) years of professional clinical experience.
- Strong knowledge of medical terminology, clinical practice, treatment planning, medical documentation, and generally accepted standards of care, with the ability to interpret medical records, diagnostic results, imaging, treatment plans, and other clinical documentation.
- Strong analytical and critical-thinking skills with the ability to independently evaluate clinical information and develop objective, evidence-based clinical determinations.
- Ability to clearly and concisely document clinical review findings, conclusions, and supporting rationale.
- Strong attention to detail, organizational skills, and the ability to work independently while meeting established quality, productivity, and project timelines in a remote environment.
Preferred Qualifications
- Board certification or board eligibility in a medical specialty relevant to the assigned reviews.
- Experience in internal medicine, family medicine, psychiatry, or another specialty applicable to the review assignment.
- Experience treating Medicaid populations or working with Medicaid programs.
- Previous experience conducting medical record review, claims review, utilization review, medical necessity review, peer review, payment integrity review, or retrospective clinical review.
- Familiarity with Medicaid coverage policies, medical necessity requirements, and healthcare program integrity concepts.
- Experience evaluating potentially improper, excessive, unsupported, or medically unnecessary healthcare services.
- Familiarity with medical coding, including CPT/HCPCS and ICD-10-CM, and the relationship between clinical documentation and billed services.
- Experience supporting health plans, Medicaid agencies, Medicare, other government healthcare programs, or healthcare program integrity initiatives.
Benefits
U.S. remote annual hourly rate range: $80.00-$145.000
For candidates in jurisdictions requiring range disclosure, this is the good-faith range for this role; final pay may vary by work location and job-related factors such as skills, experience, location, and internal equity. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
IntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, and gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
About Us
www.integritym.com
Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.
At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!
Position Summary
The Medical Clinical Review Consultant provides professional medical expertise in support of healthcare claim reviews by conducting independent clinical evaluations of claims and supporting documentation, including medical records, treatment plans, clinical notes, diagnostic testing, imaging, procedure documentation, and relevant claims data. The Consultant assesses medical necessity, clinical appropriateness, quality of care, and whether the documentation supports the services billed, and develops objective, well-supported clinical determinations in accordance with applicable Medicaid policies, coverage requirements, established clinical criteria, and generally accepted standards of medical practice.
Key Responsibilities
- Conduct independent clinical reviews of healthcare claims and supporting medical documentation.
- Review medical records, treatment plans, clinical notes, diagnostic testing, imaging, procedure documentation, and other relevant clinical information.
- Evaluate services for medical necessity, clinical appropriateness, and consistency with generally accepted standards of medical practice.
- Assess whether the medical documentation supports the services, procedures, diagnoses, and level of care billed.
- Apply applicable Medicaid policies, coverage requirements, clinical criteria, and review guidelines when developing determinations.
- Identify potentially unnecessary, excessive, duplicative, unsupported, or otherwise questionable services based on the clinical documentation.
- Develop clear, objective, and well-supported clinical determinations and document the rationale for review findings.
- Respond to requests for clarification or additional clinical analysis regarding completed reviews.
- Escalate complex clinical or policy questions as appropriate and participate in clinical discussions when needed.
- Maintain consistency, accuracy, and objectivity across assigned reviews.
- Meet established quality, productivity, and project timelines.
- Maintain the confidentiality and security of protected health information and comply with applicable HIPAA and data security requirements.
Requirements
Required Qualifications
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school.
- Current, active, and unrestricted license to practice medicine in at least one U.S. state or jurisdiction.
- Medical license must be in good standing, with no current restrictions, suspensions, or disciplinary limitations that would affect the ability to perform clinical reviews.
- Minimum of two (2) years of professional clinical experience.
- Strong knowledge of medical terminology, clinical practice, treatment planning, medical documentation, and generally accepted standards of care, with the ability to interpret medical records, diagnostic results, imaging, treatment plans, and other clinical documentation.
- Strong analytical and critical-thinking skills with the ability to independently evaluate clinical information and develop objective, evidence-based clinical determinations.
- Ability to clearly and concisely document clinical review findings, conclusions, and supporting rationale.
- Strong attention to detail, organizational skills, and the ability to work independently while meeting established quality, productivity, and project timelines in a remote environment.
Preferred Qualifications
- Board certification or board eligibility in a medical specialty relevant to the assigned reviews.
- Experience in internal medicine, family medicine, psychiatry, or another specialty applicable to the review assignment.
- Experience treating Medicaid populations or working with Medicaid programs.
- Previous experience conducting medical record review, claims review, utilization review, medical necessity review, peer review, payment integrity review, or retrospective clinical review.
- Familiarity with Medicaid coverage policies, medical necessity requirements, and healthcare program integrity concepts.
- Experience evaluating potentially improper, excessive, unsupported, or medically unnecessary healthcare services.
- Familiarity with medical coding, including CPT/HCPCS and ICD-10-CM, and the relationship between clinical documentation and billed services.
- Experience supporting health plans, Medicaid agencies, Medicare, other government healthcare programs, or healthcare program integrity initiatives.
Benefits
U.S. remote annual hourly rate range: $80.00-$145.000
For candidates in jurisdictions requiring range disclosure, this is the good-faith range for this role; final pay may vary by work location and job-related factors such as skills, experience, location, and internal equity. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
IntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, and gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
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Who's Hiring
- ChenMed10
- Dane Street8
- Michigan Peer Review Organization3M
- Toney HealthCare Consulting2T
- Tango1
Top Industries Hiring
- Insurance
What Employers Look For
The qualifications that appear most often in remote physician reviewer jobs.
- Active, unrestricted medical license in at least one U.S. state
- Board certification in a relevant clinical specialty such as internal medicine or orthopedics
- Minimum two to five years of direct patient care experience post-residency
- Working knowledge of InterQual or MCG medical necessity criteria
- Experience with ICD-10 coding and clinical documentation review
- Familiarity with utilization management processes and regulatory compliance standards
Tips for Your Remote Physician Reviewer Job Search
Prove async clinical communication in your materials
Remote physician reviewer employers screen for written reasoning above almost everything else. Include concrete examples of utilization review decisions, peer-to-peer summaries, or denial rationale you've authored. Strong written output signals you can work independently without verbal back-and-forth.
Apply early to remote roles that fit
Migrate Mate lists remote physician reviewer openings from across the U.S. in one place, so you can find roles that match your specialty and clinical background and apply directly without sifting through unrelated postings.
Target companies using InterQual or MCG criteria
Most remote utilization management firms and IROs standardize on InterQual or MCG. Naming your hands-on familiarity with either criteria set in your application materials immediately signals fit and cuts through generic physician applicants who list only their specialty.
Prepare for asynchronous remote interviews
Many remote physician reviewer employers use recorded video or written case assessments early in the hiring process. Practice articulating your clinical rationale clearly and concisely in writing, since those formats reveal exactly the skills the role demands from day one.
Remote Physician Reviewer Jobs: Frequently Asked Questions
How do I get a remote physician reviewer job?
Remote physician reviewer roles go to candidates who can demonstrate strong independent judgment, precise written clinical reasoning, and the discipline to meet turnaround requirements without direct supervision. Insurers and utilization management firms hiring remotely screen heavily for documentation quality and evidence-based decision-making, so a portfolio of prior review work, audit outcomes, or peer review experience gives you a concrete edge over candidates who rely only on credentials.
Which companies hire remote physician reviewers?
Remote physician reviewer roles are posted by ChenMed, Dane Street, and Michigan Peer Review Organization and others right now, based on current remote listings on Migrate Mate as of September 2026. The employers hiring this role remotely tend to be managed care organizations, independent review organizations, and health tech platforms that run distributed clinical operations teams.
Can you get a remote physician reviewer job with no experience?
Yes, but remote entry-level physician reviewer roles are harder to land because you're expected to work independently from day one with minimal onboarding support. Remote-first IROs and utilization management startups are more likely to consider newer reviewers. Showing case volume from clinical practice, familiarity with InterQual or MCG criteria, and any prior documentation-heavy work helps substitute for formal review experience.
Do you need a degree for remote physician reviewer jobs?
Not always in the credential sense you might expect. Remote employers consistently require an active medical license, but beyond that they weigh clinical specialty alignment, quality of written reasoning, and demonstrated familiarity with evidence-based review criteria over advanced academic degrees. Physicians with strong clinical backgrounds and clean licensure records are competitive regardless of whether they hold additional graduate credentials.
Which industries hire the most remote physician reviewers?
Remote physician reviewer roles concentrate in Insurance, based on current remote listings on Migrate Mate as of September 2026. Those sectors rely on distributed review teams because case volume is high, turnaround timelines are tight, and the work is documentation-based rather than hands-on, making it well-suited to fully remote clinical operations.
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