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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 ...

Ampcus

Clinical Medical Review Nurse

Owings Mills, MD · On-site

Clinical Medical Review Nurse. Location: Owings Mills, MD. Summary: * The Contingent RN supports CareFirst by analyzing highcost claimant and population health data to support utilization review ...

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 ...

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 ...

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 ...

Molina Healthcare

Medical Review Nurse (RN)

Long Beach, CA · On-site

$26.14 - $56.64/hr

Facilitates medical review of prospective, retrospective, and concurrent review of appeals for ... At least 2 years clinical nursing experience, including at least 1 year of utilization review ...

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Medical Review Nurse information

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How much do medical review nurse jobs pay per hour?

As of Aug 12, 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 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Clinical Medical Review Nurse

Lumen Solutions Group Inc.

Baltimore, MD • On-site

Other

Posted 2 days ago

New

Job description

Clinical Medical Review Nurse

We are seeking Licensed Practical Nurses (LPN) or Registered Nurses (RN) to join the Quality team as Clinical Medical Review Nurses. This is a hybrid contract position requiring both remote work and regular onsite presence at the Canton, MD office. Nurses will support the review and abstraction of medical records to ensure accuracy and compliance with quality standards.

Key responsibilities include:

  • Review and abstract data from medical records
  • Extract relevant clinical data using Electronic Medical Record (EMR) systems
  • Participate in periodic onsite provider visits (minimum once per month) to retrieve medical records
  • Attend mandatory in-person training in January and again in June or July
  • Use basic Excel to enter, track, and manage clinical data
  • Work collaboratively with internal QA and clinical teams

Qualifications:

  • Active RN, LPN, or Compact Nursing License (must be current and in good standing)
  • Minimum 5 years of clinical experience
  • Experience with medical record review and data abstraction
  • Proficiency with Electronic Medical Record (EMR) systems
  • Basic knowledge of Microsoft Excel
  • Must reside in the state of Maryland (MD)
  • Willingness to be onsite 2–3 days/week in Canton, MD and travel to provider offices as needed

Preferred qualifications:

  • HEDIS experience (preferred but not required)
  • Nursing degree (Associate or Bachelor's – a plus)

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