Top 42 Clinical reviewer Jobs in Pennsylvania

Clinical Compliance Reviewer
Tobii Dynavox —Pennsylvania
- Full-time
- Microsoft Word
- Microsoft Excel
- Mid-level
Clinical Record Reviewer - RN - Home Health Remote
Lehigh Valley Health Network —Allentown, PA
- 8 hour shift
- Remote
- Nursing
- RN License
- Mid-level
14d
Contract Clinical Auditor
Marsh McLennan Agency —Conshohocken, PA
- $175 a day
- Part-time
- Remote
- RN License
- HIPAA
- Mid-level
Quality Clinical Reviewer - (Onsite in Hollidaysburg, PA)
Magellan Health —Hollidaysburg, PA
- $70,715 - $113,145 a year
- Full-time
- LMFT
- Nursing
- RN License
8d
Nurse Reviewer RN
Federal Hearings And Appeals —Wilkes-Barre, PA
- $67,500 - $95,000 a year
- Full-time
- RN License
- Mid-level
- Analysis skills
Quick Apply
6d
Review Coordinator
National Medical Reviews —Warminster, PA
- $65,000 - $70,000 a year
- Full-time
- Mid-level
- Ability to sit for extended periods
- Recruiting
Quick Apply
Elsevier Clinical Content Reviewer, Specialty Specific (Part-Time, Fixed Term Contract)
Osmosis —Philadelphia, PA
- $70 - $80 an hour
- Part-time
- Remote
- Medicine
- Microsoft Excel
- Microsoft Outlook
- Parental leave
- Flexible schedule
Quick Apply
Physician Reviewer Multiple Specialties - TEXAS and NEW MEXICO
Federal Hearings And Appeals —Wilkes-Barre, PA
- Contract
- Remote
- Medicine
- Surgery
- Addiction Medicine
Quick Apply
IBHS Clinical Documentation Reviewer
Dunbar Wellness Group —Philadelphia, PA
- $62,000 - $75,000 a year
- Full-time
- HIPAA
- Mid-level
- Office
- Paid time off
Quick Apply
Medical Content Analyst, Specialist (Pre-Pay Policy)
Lyric —Pennsylvania
- $125,241 - $187,862 a year
- Full-time
- Remote
- Nursing
- Mid-level
- 3 years
Pharmacy Coordinator
Highmark Inc. —Pennsylvania
- $19.39 - $24.19 an hour
- Full-time
- Remote
- Microsoft Word
- Microsoft Outlook
- Mid-level
Clinical Care Reviewer (County Care Management Manager, Local Government) Fayette County MH/ID
Commonwealth of PA —Uniontown, PA
- $64,896 a year
- Urgently hiring
- Nursing
- Psychiatry
- Addiction Medicine
8d
Compliance Director
Quality Healthcare Group, Inc —Glenolden, PA
- Email
- Nursing
- Writing skills
- Office
Quick Apply
Diabetes Education Specialist - Inpatient
Lehigh Valley Health Network —Allentown, PA
- Full-time
- Nursing
- RN License
- BLS Certification
Authorization Specialist
OSS Health —York, PA
- Monday to Friday
- Hybrid work
- Anatomy knowledge
- Mid-level
- High school diploma or GED
- Profit sharing
- Disability insurance
Part-Time Utilization Specialist- OMY
WES Health System —Philadelphia, PA
- $45,000 - $60,000 a year
- Full-time
- Microsoft Excel
- Psychiatry
- Computer literacy
Quick Apply
Medical Director, Utilization Management
UPMC —Pittsburgh, PA
- Full-time
- Remote
- Medicine
- Management
- 5 years
- Opportunities for advancement
Associate Director, Home and Community Supports
SpArc Philadelphia —Philadelphia, PA
- Email
- Google Workspace
- Writing skills
- Office
Board-Certified Neuropsychologist
Dane Street, LLC —Reading, PA
- Contract
- Analysis skills
- Psychology
- Senior level
Quick Apply
Sr. Director, Epidemiology - Hematology
Merck —Philadelphia, PA
- $190,800 - $300,300 a year
- Full-time
- 8 years
- Doctor of Philosophy
- Travel
- Paid holidays
- Health insurance

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clinical reviewer jobs near pennsylvania

Clinical Compliance Reviewer

Tobii Dynavox -
Pennsylvania

Apply Now

Job Details

Full-time

Qualifications

Stakeholder relationship building

Full Job Description

Why join us?

We’re on a mission to empower people with disabilities to do what they once did or never thought possible. As the world-leader in assistive communication solutions, we empower our customers to express themselves, connect with the world, and live richer lives.

At Tobii Dynavox, you can grow your career within a dynamic, global company that has a clear, impactful purpose - with the flexibility to also do what truly matters to you outside of work. What’s more, you’ll be part of a work culture where collaboration is the norm and individuality is welcomed.

As a member of our team, you’ll have the power to make it happen. You’ll solve challenges, deliver solutions and develop new, efficient processes that make a direct impact on our customers’ lives.

What you’ll do:

The Clinical Compliance Reviewer is responsible for ensuring that clinical documentation—particularly Speech-Language Pathology (SLP) evaluations—meets payer-specific insurance coverage criteria to support successful funding outcomes. This role serves as a critical bridge between clinical documentation and funding requirements, providing expert review, feedback, and guidance to reduce the risk of denials and streamline the funding process.

In addition to conducting detailed reviews, the Clinical Compliance Reviewer actively supports initiatives to reduce the administrative and documentation burden on SLPs by improving report quality, clarity, and alignment with payer expectations.

As a Clinical Documentation Reviewer, you will be responsible for:

Clinical Documentation Review

Perform comprehensive reviews of SLP evaluation reports and related clinical documentation to ensure alignment with payer-specific coverage criteria and policies.
Evaluate documentation for completeness, accuracy, and medical necessity in accordance with insurance requirements, including detailed clinical rationale and supporting evidence.
Utilize established criteria checklists to validate that all required components are present and meet payer expectations.
Identify gaps, inconsistencies, or risks that may lead to funding delays, denials, or requests for additional information.

Funding Process Support

Support the funding workflow by ensuring clinical documentation is audit-ready and aligned with insurance coverage requirements prior to submission.
Collaborate with funding teams to resolve clinical documentation issues and facilitate timely progression of cases through the funding pipeline.
Provide consultative input on cases requiring clinical interpretation of payer policies or criteria.

SLP Support & Documentation Optimization

Provide clear, actionable feedback to SLPs to improve the quality and compliance of evaluation reports, including guidance on payer-specific expectations.
Support SLPs through direct communication, education, and one-on-one guidance to help them navigate documentation requirements and reduce revisions.
Contribute to the development and refinement of tools, templates, and resources designed to simplify the report writing and funding process.
Partner with internal teams to identify trends in denials or documentation challenges and implement proactive solutions.

Policy & Criteria Management

Assist in maintaining and updating payer-specific clinical criteria checklists and documentation standards.
Collaborate with policy and compliance teams to ensure clinical review processes remain aligned with evolving insurance requirements.
Provide feedback on emerging payer trends, documentation risks, and opportunities for process improvement.

What you'll bring:

Bachelor’s Degree and/or 3-5 years healthcare/clinical-related experience
Background in clinical or clinical-related field
Knowledge of DME Billing and Prior Authorizations
Technical writing skills
Intermediate level skills in Microsoft Word & Excel with ability to learn additional systems as needed
Communication skills (written, oral and interpersonal)
Able to work independently and within a team environment
Interpersonal skills to build relationships with recommenders
Familiarity of the healthcare field
Knowledge of Medicare, Medicaid, Commercial Insurance
Time Management
Decision-making and problem-solving skills
Proper grammar skills
Phone etiquette skills
Ability to work with interruptions
Flexibility to adapt to new projects

Apply today!

We believe in empowering individuals - including our own employees - to reach their full potential. So, if you want to change lives while growing your own career, we’d love to hear from you.

Where we stand:

We believe diversity not only enriches our workplace culture, but also gives us a strategic advantage. Working with people from a variety of backgrounds and perspectives helps us all become better communicators, better problem solvers, and better human beings. Our differences make us stronger.

Tobii Dynavox values equality of opportunity, human dignity, and racial/ethnic and cultural diversity. Tobii Dynavox does not discriminate against individuals on the basis of race, color, sex, sexual orientation, gender identity, religion, disability, age, veteran status, ancestry, or national or ethnic origin.

Equal Opportunity Employer/AA Women/Minorities/Veterans/Disabled

Apply Now

Refine Your Search

clinical reviewer jobs in pennsylvania

Clinical Compliance Reviewer

Clinical Record Reviewer - RN - Home Health Remote

Contract Clinical Auditor

Quality Clinical Reviewer - (Onsite in Hollidaysburg, PA)

Nurse Reviewer RN

Review Coordinator

Elsevier Clinical Content Reviewer, Specialty Specific (Part-Time, Fixed Term Contract)

Physician Reviewer Multiple Specialties - TEXAS and NEW MEXICO

IBHS Clinical Documentation Reviewer

Medical Content Analyst, Specialist (Pre-Pay Policy)

Pharmacy Coordinator

Clinical Care Reviewer (County Care Management Manager, Local Government) Fayette County MH/ID

Compliance Director

Diabetes Education Specialist - Inpatient

Authorization Specialist

Part-Time Utilization Specialist- OMY

Medical Director, Utilization Management

Associate Director, Home and Community Supports

Board-Certified Neuropsychologist

Sr. Director, Epidemiology - Hematology

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