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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 ...

Peraton

Medical Review Nurse- Medicare

Herndon, VA · On-site

$66K - $106K/yr

Medical Review Nurse- Medicare Job Locations US Requisition ID 2026-169533 Position Category Business Controls Clearance No Clearance Required Responsibilities SafeGuard Services (SGS), a subsidiary ...

Peraton

Medical Review Nurse- Medicare

Reston, VA · On-site

$66K - $106K/yr

Medical Review Nurse- Medicare Job Locations US Requisition ID 2026-169533 Position Category Business Controls Clearance No Clearance Required Responsibilities SafeGuard Services (SGS), a subsidiary ...

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 ...

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 ...

Peraton

Medical Review Nurse- Medicare

$66K - $106K/yr

We are looking to add a Nurse Reviewer to our SGS team of talented professionals. What you'll do: The position requires the individual to conduct medical record reviews and to apply sound clinical ...

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 ...

Peraton

Medical Review Nurse- Medicaid

$66K - $106K/yr

We are looking to add a Nurse Reviewer to our SGS team of talented professionals. What you'll do: The position requires the individual to conduct medical record reviews and to apply sound clinical ...

Peraton

Medical Review Nurse- Medicare

$66K - $106K/yr

We are looking to add a Nurse Reviewer to our SGS team of talented professionals. What you'll do: The position requires the individual to conduct medical record reviews and to apply sound clinical ...

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How much do medical review nurse jobs pay per hour?

As of Aug 23, 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.

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.

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 do you become a medical review nurse?

To become a medical review nurse, you typically need to hold a registered nurse (RN) license by completing an accredited nursing program and passing the NCLEX-RN exam. Relevant experience in medical or clinical settings and knowledge of healthcare regulations are also important, and some roles may require certification in case management or utilization review.
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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, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Medical Review Nurse

ST CROIX HOSPICE LLC

Mendota Heights, MN • On-site, Remote

Full-time

Posted 2 days ago

New

St. Croix Hospice rating

8.5

Company rating: 8.5 out of 10

Based on 33 frontline employees who took The Breakroom Quiz

5th of 46 rated hospices

Job description

Work Where You Matter!
At St. Croix Hospice we guide patients and families through the end-of-life journey. Through compassionate care, we focus on our patient's quality of life, empowering them to make the most of their time with dignity, comfort and respect. If you are ready to be part of an extraordinary team of caregivers, then come work where you matter.
Medical Review Nurse
Position Overview
The Medical Review Nurse is an experienced nurse responsible for the monitoring, implementation and evaluation of processes and programs to ensure they meet regulatory, accreditation and standards of practice.
Essential Functions and Skills
  • Responsible for the implementation and monitoring of the organization's quality assessment performance improvement (QAPI) program.
    • Monitors and measures activities related to QAPI as assigned.
    • Implements quality improvement activities utilizing continuous quality improvement principles and methodologies.
    • Implements established schedule for clinical record review and data collection.
    • Compiles, trends, and reports quality data in the following areas: patient care, safety, risk management, infection control, outcomes, and customer satisfaction.
    • Works collaboratively with nursing department to assure documentation is complete and consistent with care and reflects regulatory/legal requirements.
  • Responsible for implementing processes to monitor and evaluate safety, risk management and infection control programs.
    • Implements monitoring activities for safety, risk management, and infection control.
    • Assists with mandatory in-service programs on OSHA regulations for safety and infection control as requested.
    • Acts as resource to staff in identifying safety and risk management issues for patients and staff.
    • Reviews all incident reports for completeness, risk, standard of care determination and appropriate follow-up. Trends data and makes recommendations related to trends identified.
    • Maintains current knowledge related to home care safety and infection control standards.
  • Monitor organization compliance with regulatory and accreditation standards.
    • Maintains current knowledge related to Medicare Conditions of Participation and the Community Health Accreditation Program's (CHAP) standards to ensure that the organization is compliant with state, federal and accreditation guidelines.
    • Participates in review of policies and procedures and makes recommendations for policy changes to the Director of Quality Assurance.
    • Acts as a resource to the clinical team regarding standards, policies, and regulations.
  • Acts as a clinical resource to staff.
    • Maintains updated nursing knowledge and skills.
    • Assists with patient visits as needed.
  • Promote self-growth and collegial relationships with others in the home care industry.
    • Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal and professional networks and participating in professional organizations or societies.
  • Reviews Medical Records to ensure standards and compliance are being met across the organization.
  • Reviews live discharges to ensure appropriateness and compliance.
  • Completes audits as required by survey or self- identified to ensure compliance in medical records.
  • Performs other duties as assigned.

Requirements/Qualifications
  • Must have a current Registered Nurse (RN) license in state(s) of practice.
  • 2+ years of Nursing experience.
  • Nurses holding a multistate license can practice in other states without obtaining additional licenses while maintaining their Registered Nurse (RN) license in their primary state of residence (PSOR). Minnesota, Michigan, and Illinois are not in the Nursing Licensure Compact.
  • Graduate of an accredited school of professional nursing.
  • If Driving: Valid State Driver's License, access to an automobile in good working order, automobile insurance in accordance with state and organizational requirements, and an acceptable driving record required.
  • Ability to pass DHS background study

Physical Requirements
The physical requirements described are representative of those that must be met to successfully perform the essential responsibilities of this position. Reasonable accommodation may be made.
  • Pushing/Pulling and Lifting/carrying up to 30 pounds. Occasionally up to 50 pounds.
  • Prolonged periods sitting at a desk and working on a computer.
  • Ability to adapt to a variety of work conditions to ensure the highest quality of patient care in a home setting.
  • May be exposed to infections and contagious diseases. Contact with patients under wide variety of circumstances. May be exposed to/occasionally exposed to patient elements. Subject to varying and unpredictable situations. Travel required. OSHA exposure category: Category I - Position includes tasks that involve exposure to blood, body fluids, tissues. Category II - Position includes tasks that involve no exposure to blood, body fluids, tissues, but employment may require unplanned Category I tasks. Category III - Position includes tasks that involve no exposure to blood, body fluids, tissues; would not be required to perform Category I tasks.

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