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Clinical Review Nurse Jobs (NOW HIRING)

TPIS

Clinical Review Nurse

San Juan, PR · On-site

$250/hr

Clinical Review Nurse San Juan, PR, PR Salary: $21.00 Annually This role investigates Health Insurance Waste and Error stopped claims by gathering information, researching state and federal ...

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Actalent

Clinical Review Nurse - Remote

$34 - $40/hr

Clinical Review Nurse (Remote) Make a meaningful impact on patient care from the comfort of your home. We are seeking an experienced Clinical Review Nurse (RN) to join our growing healthcare team. In ...

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$89.9K

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How much do clinical review nurse jobs pay per year?

As of Sep 8, 2026, the average yearly pay for clinical review nurse in the United States is $89,949.00, according to ZipRecruiter salary data. Most workers in this role earn between $71,000.00 and $104,500.00 per year, depending on experience, location, and employer.

What is a clinical review nurse?

A Clinical Review Nurse evaluates medical records and treatment plans to ensure compliance with healthcare guidelines and regulations. They work with insurance companies, healthcare providers, and patients to assess the necessity and appropriateness of medical care. Their responsibilities include reviewing claims, verifying documentation, and making determinations based on medical policies. This role requires strong analytical skills, attention to detail, and knowledge of medical terminology and procedures.

What does a clinical review nurse do?

A typical day for a Clinical Review Nurse involves reviewing patient medical records, assessing treatment plans for appropriateness and compliance with insurance or regulatory guidelines, and communicating findings to healthcare providers, insurers, or case managers. You may participate in interdisciplinary meetings, answer provider inquiries, and help resolve issues related to medical necessity or coverage determinations. Most work is desk-based, often in a remote or office setting, with a focus on timely and accurate documentation. The role requires balancing independent work with frequent collaboration and communication across clinical and administrative teams.

What are the key skills and qualifications needed to thrive as a clinical review nurse?

To excel as a Clinical Review Nurse, you need a current RN license, strong clinical judgment, and experience in reviewing and interpreting medical records. Familiarity with utilization management software, electronic health records (EHRs), and case management systems is typically required. Attention to detail, analytical thinking, effective communication, and the ability to work independently are highly valued soft skills in this position. These skills ensure accurate evaluations of clinical documentation, support quality care decisions, and promote collaboration across healthcare teams.

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Clinical Review Nurse jobs near you
Infographic showing various Clinical Review Nurse job openings in the United States as of September 2026, with employment types broken down into 3% As Needed, 74% Full Time, 16% Part Time, and 7% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $89,949 per year, or $43.2 per hour.

Clinical Review Nurse

TurningPoint Healthcare Solutions, LLC

Lake Mary, FL • On-site

Full-time

Re-posted 3 hours ago

Job description

TurningPoint Healthcare Solutions is a rapidly growing and innovative healthcare company that supports several large national health plans to improve the quality and affordability of healthcare patients receive. We are looking for motivated individuals who want to be part of our mission and join our team!

As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with established medical criteria to perform first level clinical review for select procedures that require medical necessity authorization. We are seeking individuals who enjoy a challenge, have an ability to work independently and are capable of meeting deadlines. Previous utilization management experience is preferred. In addition to prior experience, the ideal candidate will have an extreme attention to detail, an ability to flourish in a fast-paced environment and advanced grammar, punctuation, and computer skills.

Responsibilities

  • Perform initial clinical reviews and provide documented recommendations based on the use of appropriate clinical guidelines
  • Review the initial evaluation and clinical documentation against clinical standards, applicable state regulations and relevant treatment guidelines
  • Assist clinical staff in quality improvement projects to provide instructive feedback to clients and providers within scope of practice
  • Resolve patient care issues by working one-on-one with community providers and staff to resolve issues in the determination process
  • Provide information by responding to queries of physicians and their practice staff, sorting and distributing messages and documents, and preparing information for determinations
  • Improve quality results by studying, evaluating procedures and processes and recommending changes, if needed
  • Serves and protects the company by adhering to accreditation standards, professional standards, company policies and procedures, federal, state, and local requirements, and professional and licensing standards

Qualifications:

  • Licensed Nurse Practitioner (LPN) or Registered Nurse (RN) required
  • Comprehensive knowledge of general nursing theory and practices
  • Excellent customer service skills and phone etiquette
  • Proficient computer skills, including typing and an ability to maneuver through various programs
  • Previous Utilization Management experience preferred but not required
  • Knowledge of musculoskeletal surgical procedures, cardiac procedures, pain management and/ or wound care is a plus
  • Ability to multi-task and manage tasks to completion on a timely basis and in an organized fashion
  • Ability to work collaboratively as part of a team
Salary:
RN- 62k-68k
LPN- 52k-58k

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