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Medical Review Manager Jobs (NOW HIRING)

HealthPartners

Medical Review Investigator

Bloomington, MN · On-site

  • Medical

  • Retirement

The Medical Review Investigator is responsible for the intake, investigation, and resolution of ... Strong communication and stakeholder management skills. * Proficient in drafting detailed and ...

Empower AI Inc.

Review medical documentation for medical necessity utilizing clinical knowledge and Center for ... Organization and time management skills * Knowledge of and ability to use Microsoft Excel and word ...

Empower AI Inc.

Medical Review Specialist V

Review medical documentation for medical necessity utilizing clinical knowledge and Center for ... Organization and time management skills * Knowledge of and ability to use Microsoft Excel and word ...

UHS

Utilization Review Manager

Phoenix, AZ

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position ... Excellent Medical, Dental, Vision and Prescription Drug Plans * 401(K) with company match and ...

UHS

Utilization Review Manager

Phoenix, AZ

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position ... Excellent Medical, Dental, Vision and Prescription Drug Plans * 401(K) with company match and ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsibilities Benefit Highlights: • Excellent Medical, Dental, Vision and Prescription Drug ... Review Manager. Position Description: The Utilization Manager is responsible for directing and ...

Empower AI Inc.

Medical Review Specialist V

Review medical documentation for medical necessity utilizing clinical knowledge and Center for ... Organization and time management skills * Knowledge of and ability to use Microsoft Excel and word ...

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited Independent Review Organization (IRO) that provides objective, evidence-based medical peer reviews nationwide.

UHS

Utilization Review Manager

Grand Rapids, MI

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsibilities Benefit Highlights: · Excellent Medical, Dental, Vision and Prescription Drug ... Review Manager. Position Description: The Utilization Manager is responsible for directing and ...

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Medical Review Manager information

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How much do medical review manager jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for medical review manager in the United States is $44.26, according to ZipRecruiter salary data. Most workers in this role earn between $28.85 and $57.69 per hour, depending on experience, location, and employer.

What does a medical review manager do?

A Medical Review Manager oversees the evaluation of medical information, typically within clinical trials or insurance contexts, to ensure compliance with regulations and company standards. They lead teams that review medical documents, patient records, or clinical data to assess safety, efficacy, and adherence to protocols. Additionally, they collaborate with medical professionals, regulatory bodies, and other departments to resolve issues and improve review processes. Their role is crucial in maintaining the quality and accuracy of medical assessments and supporting organizational goals.

What are the key skills and qualifications needed to thrive as a medical review manager?

To thrive as a Medical Review Manager, you need a solid background in healthcare or life sciences, experience in clinical or medical review, and often a relevant degree such as RN, MD, or PharmD. Familiarity with regulatory guidelines, medical coding systems, and tools like MedDRA or clinical trial management software is typically required. Strong analytical thinking, attention to detail, and effective communication are essential soft skills for success in this role. These competencies ensure accurate medical evaluations, regulatory compliance, and seamless collaboration with cross-functional teams.

What are the typical challenges faced by a medical review manager when collaborating with cross-functional teams?

Medical Review Managers often collaborate with clinical, regulatory, and safety teams, which can present challenges such as aligning differing priorities and timelines. Effective communication and strong organizational skills are crucial to ensure that all stakeholders are updated and that the review process runs smoothly. Navigating complex regulatory requirements and integrating feedback from multiple departments can also require adaptability and diplomatic problem-solving. Building strong relationships across teams helps streamline workflows and supports successful project outcomes.

What is the difference between Medical Review Manager vs Medical Reviewer?

AspectMedical Review ManagerMedical Reviewer
CertificationsMedical license, possibly additional certifications in clinical reviewMedical license, often with specific clinical review certifications
Work EnvironmentOversees review teams, manages processes, and ensures compliancePerforms clinical reviews, evaluates medical records and claims
Employer & Industry UsageInsurance companies, healthcare organizations, government agenciesInsurance companies, healthcare providers, third-party review organizations

The Medical Review Manager typically supervises review teams and manages review processes, requiring leadership skills and extensive clinical knowledge. In contrast, the Medical Reviewer focuses on conducting detailed medical evaluations and assessments. Both roles require medical licensure and clinical expertise, but the Manager has additional responsibilities in oversight and process management.

How to become a medical review manager?

To become a medical review manager, candidates typically need a medical degree such as a medical doctor (MD) or registered nurse (RN) license, along with experience in healthcare or medical claims review. Strong analytical skills, knowledge of medical coding and documentation, and familiarity with healthcare regulations are essential, and some roles may require certification such as Certified Medical Review Officer (CMRO).
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Medical Review Manager jobs near you

Medical Review Investigator

HealthPartners

Bloomington, MN • On-site

Other

Medical, Retirement

Re-posted 4 days ago

HealthPartners rating

7.6

Company rating: 7.6 out of 10

Based on 135 frontline employees who took The Breakroom Quiz

189th of 887 rated healthcare providers

Job description


HealthPartners is hiring a Medical Review Investigator. The Medical Review Investigator is responsible for the intake, investigation, and resolution of potential Fraud, Waste, and Abuse (FWA) allegations involving Medicaid, Medicare, and Commercial (fully and self-insured) product lines. Primary responsibilities include evaluating allegations, analyzing claims data, reviewing medical records, conducting interviews, and performing investigative site visits. This role requires frequent collaboration with both internal departments and external stakeholders.
MINIMUM QUALIFICATIONS:
  • Education, Experience or Equivalent Combination:
  • Bachelor's degree in relevant field, or 4-7 years of Investigative Experience
  • Knowledge, Skills, and Abilities:
  • Proficient in using personal computers, word processing, and spreadsheets.
  • Strong communication and stakeholder management skills.
  • Proficient in drafting detailed and accurate written reports.
  • Excellent presentation, planning and organizational skills.
  • Strong analytical skills with the ability to assess complex situations and identify effective solutions.
PREFERRED QUALIFICATIONS:
  • Education, Experience or Equivalent Combination:
  • 2 years' experience in medical fraud, waste, and abuse (FWA) investigations.
  • Licensure/ Registration/ Certification:
  • Professional certification as a Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AHFI), or similar.
  • Knowledge, Skills, and Abilities:
    • Experienced in using data analysis to uncover trends and patterns.
  • Understanding of the current FWA landscape and trends with the ability to adapt to shifting priorities and evolving requirements.
  • Demonstrated familiarity with CPT codes and terminology.
ESSENTIAL DUTIES:
  1. (70%) - Investigate allegations of potential FWA.
  2. (10%) - Perform prepayment activities, including obtaining and analyzing records.
  3. (10%) - Prepare detailed investigation reports, interview summaries, and regulatory referrals.
  4. (10%) - Identify opportunities for, and contribute to, FWA mitigation strategies including claim system edits, outlier dashboards, corrective action plans, and reimbursement policies.

*Job description rankings/percentages are intended to reflect normal averages over an extended period of time, and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs.
ORGANIZATIONAL EXPECTATIONS:
Values
All colleagues are expected to live our values:
Excellence: We strive for the best results and always look for ways to improve.
Compassion: We care and show empathy and respect for each person.
Partnership: We are strongest when we work together and with those we serve.
Integrity: We are open and honest, and we keep our commitments.
Additional Expectations:
  • Manage an investigative caseload, including timely documentation and reporting of case activities.
  • Research and apply internal and external policies, procedures, laws, and/or regulations.
  • Identify and analyze suspicious billing patterns, trends, and anomalies.
  • Interview professionals, witnesses, and patients/members.
  • Perform investigative provider site visits.
  • Collaborate with internal partners including Legal, Compliance, Contracting, Credentialing, Government Programs, and the Health Plan Medical Directors
  • Serve as an internal resource and subject matter expert on FWA.
  • Demonstrate high standards of integrity and professionalism.

About Us
At HealthPartners we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Benefits Designed to Support Your Total HealthAs a HealthPartners colleague, we're committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.
Join us in our mission to improve the health and well-being of our patients, members, and communities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.

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