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Medical Review Nurse Jobs (NOW HIRING)

Ampcus

Clinical Medical Review Nurse

Baltimore, MD · On-site

Clinical Medical Review Nurse. Location: Baltimore, MD. Purpose: * The Clinical Medical Review Nurse handles day-to-day review of professional and institutional claims and provider appeals that ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

May be asked to assist with precepting of new Medical Review Nurses (MRNs). * Perform other duties and projects as assigned. Required Education and Experience * Registered Nurse, with a current ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

May be asked to assist with precepting of new Medical Review Nurses (MRNs). * Perform other duties and projects as assigned. Required Education and Experience * Registered Nurse, with a current ...

Cynet Systems

Clinical Medical Review Nurse

Baltimore, MD · On-site

$36.49 - $41.49/hr

Participate in medical policy meetings, nursing forums, and review sessions with medical and dental leadership. Contribute to special projects, task forces, and cross-functional initiatives. Perform ...

Saratoga Medical

Medical Review Manager

Catonsville, MD · On-site

Saratoga Medical has an immediate opening for a Medical Review Manager for a program supporting the ... Board Certified in Nursing and licensed to practice nursing in the U.S. and a currently licensed ...

Machinify

Medical Review Nurse - SNF/MDS Auditor

$36.50 - $47.75/hr

The Medical Review Nurse II - SNF/MDS primarily performs Skilled Nursing Facility (SNF) medical claims audit reviews. As a MR Nurse, you will join a team of experienced medical auditors performing ...

Saratoga Ascend

Medical Review Manager

Catonsville, MD · On-site

Medical Review Manager Saratoga Medical has an immediate opening for a Medical Review Manager for a ... Board certified in nursing and licensed to practice nursing in the U.S. and a currently licensed ...

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Medical Review Nurse information

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$17

$38

$65

How much do medical review nurse jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for medical review nurse in the United States is $38.62, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $43.27 per hour, depending on experience, location, and employer.

What does a medical review nurse do?

A Medical Review Nurse is a registered nurse who evaluates medical records, insurance claims, and treatment plans to ensure that healthcare services provided to patients are medically necessary and comply with established guidelines. They often work for insurance companies, government agencies, or healthcare organizations. Their main responsibilities include reviewing documentation for accuracy, determining coverage eligibility, and communicating with healthcare providers about their findings. By doing so, they help control healthcare costs and promote appropriate patient care.

What are the key skills and qualifications needed to thrive as a medical review nurse, and why are they important?

To excel as a Medical Review Nurse, you need a registered nursing license, clinical experience, and a solid understanding of medical terminology and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and industry guidelines such as Medicare and Medicaid is typically required. Strong critical thinking, attention to detail, and effective communication skills help you interpret clinical data and interact with providers and insurers. These competencies ensure accurate case evaluations, compliance with policies, and optimal patient care outcomes.

What is the difference between Medical Review Nurse vs Utilization Review Nurse?

AspectMedical Review NurseUtilization Review Nurse
CredentialsRN license, certification in case management or utilization review (e.g., CURN)RN license, certification in utilization review or case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesInsurance companies, healthcare organizations, managed care
Job FocusReviewing medical records for appropriateness of care and billingAssessing the necessity and efficiency of healthcare services
Industry UsageCommonly used in healthcare and insurance sectorsPrimarily in insurance and managed care settings

Both roles involve reviewing medical information, but Medical Review Nurses focus on clinical appropriateness and billing, while Utilization Review Nurses primarily assess the necessity of services for insurance approval. Understanding these differences helps healthcare professionals and job seekers identify the right career path or job opportunity.

How does a medical review nurse typically interact with other healthcare professionals during the review process?

Medical Review Nurses work closely with physicians, case managers, and insurance representatives to evaluate the medical necessity and appropriateness of treatments and procedures. They often communicate findings, clarify documentation, and request additional information to ensure that decisions are evidence-based and compliant with regulations. Collaboration is key, as Medical Review Nurses must balance advocating for patients with adhering to payer guidelines and organizational protocols. Regular meetings and interdisciplinary discussions are common, making strong communication skills essential for success in this role.
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Medical Review Nurse jobs near you
Infographic showing various Medical Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Clinical Medical Review Nurse

Ampcus

Baltimore, MD • On-site

Other

Re-posted 18 days ago

Job description

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team. Job Title: Clinical Medical Review Nurse. Location: Baltimore, MD. Job Description: Purpose:
  • The Clinical Medical Review Nurse handles day-to-day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication.
  • The incumbent will handle pre and post claim medical review for Commercial, FEP and Medicare Advantage Plans.
  • This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies.
  • This role will also understand the merits of legal or accreditation actions.
Essential Functions:
  • 35% Receives, research, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication, performs high-level research on topics identified as actual or potential medical policies. Assesses and communicates impact of information on medical policy.
  • 25% Provides pricing of procedure codes which require individual consideration or are listed as "not otherwise classified" in CPT manual. Interprets the descriptive or medical information utilizing the CPT and HCPCS manuals. Keeps up to date on coding rules and standards.
  • 25% Participates in medical policy meetings, nurses' forums, and review sessions with Medical and Dental directors, special projects and task forces committees as assigned.
  • 15% Performs medical underwriting and risk assessment by reviewing applications of potential subscribers, as well as any appropriate medical records.
Qualifications:
  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
  • The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Knowledge, Skills and Abilities (KSAs):
  • Ability to effectively communicate and provide positive customer service to every internal and external customer, Proficient.
  • Strong interpersonal skills. Ability to work independently, as well as a member of a team, Advanced.
  • Current knowledge of clinical practices and related medical policies., Proficient.
  • Strong organizational skills, ability to prioritize responsibilities with attention to detail., Proficient.
  • Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology., Proficient.
  • Must possess excellent verbal and written communication skills. Advanced.
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
  • Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
  • Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Preferred Qualifications:
  • Bachelor's degree in nursing.
Experience:
  • 3 years acute clinical experience, previous case management, discharge planning or utilization review experience.
Licenses/Certifications:
  • RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA, DC and or MD Upon Hire required.
Ampcus is 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, age, protected veterans or individuals with disabilities.
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About Ampcus

Sourced by ZipRecruiter

Ampcus Inc. is a ISO 20000, ISO 27000, ISO 9001, CMMI DEV/3 SM and CMMI SVC/3 SM certified global provider of a broad range of Technology and Business consulting services. From strategy to execution, our disciplined yet flexible approach starts and ends with our clients. By listening hard and working harder, client goals become our goals. Their success is our satisfaction. It’s why our clients sleep well at night. We believe that the success of an engagement is determined by strong project management, as well as clear communication and mutual commitment working collaboratively. Our methodology begins with listening to the customer about their needs, then working with their team to gain a clear understanding of the requirements, while providing knowledge transfer of best practices for the organization.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Chantilly, VA, US

Year founded

2004

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