Medical Review Specialist (Hybrid - Local Candidates)

The Medical Review Specialist is responsible for reviewing, analyzing, and interpreting medical documentation to support eligibility determinations and alternative treatment evaluations in alignment with Christian Healthcare Ministries’ guidelines and values. This role exists to ensure medical review decisions are accurate, evidence-based, and applied consistently while maintaining compassion and clarity in member interactions.

At the highest level, the Medical Review Specialist focuses on clinical analysis, guideline interpretation, and professional judgment, supporting sound decision-making that upholds CHM’s mission, stewardship, and commitment to member care.

WHAT WE OFFER

• Compensation based on experience.
• Faith and purpose-based career opportunity!
• Fully paid health benefits
• Retirement and Life Insurance
• 12 paid holidays PLUS birthday
• Lunch is provided DAILY.
• Professional Development
• Paid Training

PRIMARY RESPONSBILITIES

• Review and analyze complex medical records to assess eligibility, appropriateness of services, and alignment with CHM medical guidelines.
• Apply clinical judgment and established criteria to support consistent, evidence-based eligibility determinations.
• Conduct medical literature reviews and research to support recommendations, alternative treatment considerations, and guideline application.
• Collaborate with the Eligibility Review Supervisor, Medical Director, and Medical Review leadership to ensure alignment and consistency in medical review decisions.
• Communicate clearly and compassionately with members and internal teams regarding medical review outcomes, addressing questions and concerns professionally.
• De-escalate sensitive or emotionally charged interactions while maintaining CHM standards and values.
• Maintain accurate documentation of medical review findings, rationale, and decisions within CHM systems.
• Stay current on medical research, industry standards, and regulatory considerations relevant to medical review activities.
• Uphold strict confidentiality and HIPAA compliance in all handling of protected health information.

CORE COMPETENCIES & SKILLS

• Medical analysis and critical thinking – Interpret complex medical information and applies clinical reasoning.
• Evidence-based decision making – Utilizes research and guidelines to support review outcomes.
• Clear and compassionate communication – Explains medical determinations in an understandable and empathetic manner.
• Case management and prioritization – Manages multiple cases while meeting accuracy and timeliness standards.
• Documentation and compliance – Maintain thorough, accurate records aligned with regulatory and internal requirements.
• Collaboration – Works effectively with leadership, medical reviewers, and cross-functional teams.

REQUIRED QUALIFICATIONS & CONSIDERATIONS

Education

• Bachelor’s degree in a healthcare-related field (e.g., nursing, health sciences, biology) preferred.
• Equivalent clinical or medical review experience may be considered in lieu of a degree.

Experience

• Prior experience in medical record review, utilization review, clinical review, or a related healthcare role preferred.
• Experience applying medical guidelines or clinical criteria to eligibility or treatment determinations strongly preferred.
• Familiarity with HIPAA regulations and protected health information handling required.
• Experience working with EMR/EHR systems, medical coding, or health information systems is a plus.

Certifications

• No certifications required at time of hire.
• Clinical licensure or healthcare-related certifications (e.g., RN, LPN, CPC) are a plus but not required.

About Christian Healthcare Ministries

Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.