Medical Necessity Review Registered Nurse Texas Institute for Surgery LL SURG - Dallas, TX 75231-5100 Description The Medical Necessity Review Registered Nurse is responsible for ensuring appropriate ...
Medical Necessity Review Registered Nurse Texas Institute for Surgery LL SURG - Dallas, TX 75231-5100 Description The Medical Necessity Review Registered Nurse is responsible for ensuring appropriate ...
The Medical Necessity Review Registered Nurse is responsible for ensuring appropriate patient status, medical necessity, and payer compliance through prospective, concurrent, and retrospective review.
The Medical Necessity Review Registered Nurse is responsible for ensuring appropriate patient status, medical necessity, and payer compliance through prospective, concurrent, and retrospective review.
The Medical Necessity Review Registered Nurse is responsible for ensuring appropriate patient status, medical necessity, and payer compliance through prospective, concurrent, and retrospective review.
The Medical Necessity Review Registered Nurse is responsible for ensuring appropriate patient status, medical necessity, and payer compliance through prospective, concurrent, and retrospective review.
We are seeking physicians to support asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal ...
We are seeking physicians to support asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal ...
We are seeking physicians to support asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal ...
Quick apply
We are seeking physicians to support asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal ...
We are seeking physicians to support asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal ...
We are seeking physicians to support asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal ...
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Tampa, FL · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Tampa, FL · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Atlanta, GA · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Atlanta, GA · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Miami, FL · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Miami, FL · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Tampa, FL · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Tampa, FL · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Atlanta, GA · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Atlanta, GA · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Wilmington, DE · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Wilmington, DE · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Grand Prairie, TX · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Grand Prairie, TX · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Grand Prairie, TX · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Nurse Reviewer 1
Grand Prairie, TX · On-site
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
Medical Necessity Reviewer information
See salary details
$11.78 - $19.84
14% of jobs
$24.28 is the 25th percentile. Wages below this are outliers.
$19.84 - $27.91
21% of jobs
The median wage is $32.08 / hr.
$27.91 - $35.97
30% of jobs
$35.97 - $44.03
9% of jobs
$46.72 is the 75th percentile. Wages above this are outliers.
$44.03 - $52.10
3% of jobs
$52.10 - $60.16
13% of jobs
$60.16 - $68.23
1% of jobs
$68.23 - $76.29
4% of jobs
$76.29 - $84.35
0% of jobs
$84.35 - $92.42
0% of jobs
$92.42 - $100.48
5% of jobs
$11
$42
$100
How much do medical necessity reviewer jobs pay per hour?
As of Aug 9, 2026, the average hourly pay for medical necessity reviewer in the United States is $42.06, according to ZipRecruiter salary data. Most workers in this role earn between $22.84 and $54.09 per hour, depending on experience, location, and employer.
What is a medical necessity reviewer?
A Medical Necessity Reviewer evaluates healthcare services, treatments, and procedures to determine if they meet medical necessity criteria based on established guidelines and insurance policies. They review patient records, consult clinical guidelines, and ensure compliance with regulatory standards. Their role helps control healthcare costs while ensuring patients receive appropriate care. Typically, they work for insurance companies, healthcare organizations, or government agencies. Strong clinical knowledge and attention to detail are essential for this role.
What are the primary responsibilities and daily tasks of a medical necessity reviewer?
As a Medical Necessity Reviewer, your primary responsibilities include reviewing clinical documentation to determine if requested medical services meet established criteria for necessity and coverage. On a typical day, you may analyze patient charts, collaborate with physicians for clarification, and communicate review outcomes to both healthcare providers and insurance payers. You'll also document your findings in compliance with policies and regulatory standards, often using utilization management platforms. In addition, you may participate in team meetings or case discussions to resolve complex cases and stay updated on changing guidelines. This role requires a balance of independent review work and teamwork to ensure the best possible patient outcomes and compliance with payer requirements.
What are the key skills and qualifications needed to thrive as a medical necessity reviewer?
To thrive as a Medical Necessity Reviewer, you need a strong knowledge of clinical guidelines, insurance policies, and medical coding, usually supported by a background in nursing or a related healthcare field. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as Certified Professional in Healthcare Quality (CPHQ) are commonly required. Strong attention to detail, effective communication, and critical thinking are valuable soft skills for success in this role. These skills are essential to accurately assess the medical necessity of procedures, ensure compliance, and facilitate clear documentation and collaboration with providers.
More about Medical Necessity Reviewer jobs
What cities are hiring for Medical Necessity Reviewer jobs? Cities with the most Medical Necessity Reviewer job openings:
What are the most commonly searched types of Medical Necessity Reviewer jobs? The most popular types of Medical Necessity Reviewer jobs are:
What states have the most Medical Necessity Reviewer jobs? States with the most job openings for Medical Necessity Reviewer jobs include:
What job categories do people searching Medical Necessity Reviewer jobs look for? The top searched job categories for Medical Necessity Reviewer jobs are:
- Diversified Medical Records Services
- Registered Nurse Clinical Denial Management
- Insurance Chart Review
- Remote Medical Records Manager
- Remote Nicu Utilization Review
- Clinical Documentation Improvement Specialist (Cdis)
- Rn Clinical Appeals Nurse
- Temporary Medical Utilization Review Physician
- Rn Clinical Denial Management
- Entry Level Revenue Cycle
Other
Posted 10 days ago
Job description
Medical Necessity Review Registered Nurse
Texas Institute for Surgery LL SURG - Dallas, TX 75231-5100
DescriptionThe Medical Necessity Review Registered Nurse is responsible for ensuring appropriate patient status, medical necessity, and payer compliance through prospective, concurrent, and retrospective review.
This role serves as the clinical lead for utilization management and a key contributor to denial prevention, partnering closely with Denial Management and Revenue Cycle teams to proactively identify, mitigate, and reduce denial risk. The role also collaborates closely with Case Management to align patient status, authorization, and progression of care with payer requirements.
Essential Duties and Responsibilities:
- Conduct admission and concurrent medical necessity reviews using established criteria and ensure appropriate patient status assignment.
- Manage payer authorizations, reviews, and communications to support reimbursement and regulatory compliance.
- Identify and mitigate denial risks through proactive review of medical necessity, documentation, and authorization requirements.
- Collaborate with physicians, case management, and revenue cycle teams to support accurate clinical documentation, patient progression, and denial prevention.
- Monitor census, length of stay, high-risk cases, and reimbursement barriers, escalating issues as needed.
- Maintain complete utilization review documentation and support audits, quality initiatives, and process improvement activities.
- Education & Training:
- Associate's degree in nursing required
- Bachelor's degree in nursing preferred
- Experience:
- 3+ years of acute care experience required
- Experience in utilization review and/or case management in an acute care hospital setting required
- Licensure/Certification/Registration:
- Current RN license in the state of Texas required
- BLS required
- Must possess and maintain a valid driver's license as employees may occasionally be required to operate a company vehicle. Reasonable accommodations may be provided as required by law.
- Key Skills:
- Comprehensive knowledge of CMS regulations, utilization management standards, and commercial payer requirements.
- Strong communication, collaboration, critical thinking, and analytical skills.
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable law.
About Texas Institute for Surgery
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
51 - 200 Employees
Headquarters location
Dallas, TX, US
Year founded
2004