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Medical Review Nurse Jobs (NOW HIRING)

Lifehealth LLC

Medical Review RN

Washington, DC · On-site

$45/hr

Medical Review RN * Date: Start Date - TBD * Shift Time: 0800-1630 M-F * Location: Washington, DC Position Summary: LifeHealth Medical Review Nurse (MRN) is responsible for the initial chart review ...

Empower AI Inc.

Medical Reviewer III (Medicare/DME)

Completes other projects or duties as assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DME)

Completes other projects or duties as assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DME)

Completes other projects or duties as assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

$28.38/hr

Completes other projects or duties assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

$28.38/hr

Completes other projects or duties assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

$28.38/hr

Completes other projects or duties assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

$28.38/hr

Completes other projects or duties assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Ensures medical director written decision is consistent with criteria (CMS, state, medical policy ...

Prime Healthcare

Medical Review Coordinator

Kankakee, IL · On-site

$31 - $44.90/hr

Kankakee, IL Coordinates and reviews all medical records, as assigned to caseload. Actively ... Nursing Graduate required. Preferred qualifications: 1. ECFMG Certification And/or Bachelor's or ...

New

Sentara Health Plans

$65 - $85/hr

Ensures medical director written decision is consistent with criteria (CMS, state, medical policy ... Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA ...

New

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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 Sep 4, 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, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Medical Review RN

Lifehealth LLC

Washington, DC • On-site

$45/hr

Part-time

Re-posted 16 hours ago

Key responsibilities

  • Performs medical review of incoming charts to determine if additional medical information is needed.

  • Performs medical Quality Assurance on all charts in various process stages.

  • Contacts Examinee via telephone or email to clarify information necessary to complete the chart.

Job description

Description
LifeHealth LLC (LifeHealth), a professional services company specializing in worksite wellness services, clinical staffing, and healthcare readiness is looking for qualified Registered Nurses (RN) responsible for the initial chart review and chart case management for medical exam/screening programs to verify that all medical information and exam components are accurate. The
RN works directly with Physicians and Examinees to ensure all medical information is gathered and performs medical Quality Assurance on all charts in various process stages leading to a final
determination.
  • Position: Medical Review RN
  • Date: Start Date - TBD
  • Shift Time: 0800-1630 M-F
  • Location: Washington, DC

Position Summary:
LifeHealth Medical Review Nurse (MRN) is responsible for the initial chart review and chart case management for medical exam/screening programs to verify that all medical information and exam components are accurate. The RN works directly with Physicians and Examinees to ensure all medical information is gathered and performs medical Quality Assurance on all charts in various process stages leading to a final determination. This position is temporary short-term position for 6-8 weeks with possible extension.
Essential Duties and Responsibilities include, but are not limited to the following:
  • Performs medical review of incoming charts to determine if additional medical information is needed.
  • Collaborates with Physician(s) and other internal nursing staff members f or chart review.
  • Performs medical Quality Assurance (QA) on all charts in various process stages.
  • Interfaces with Client's Medical Department as well as the on-site provider.
  • Contacts Examinee via telephone or email to clarify information necessary to complete the chart.
  • Develops a very good understanding of the specific contract's guidelines and addendums as required.
  • Masters the various software programs specific to the functioning of the exam program.
  • Implements and follows up on requests for further evaluation from the Examinee when required.
  • Works closely with other departments to provide accurate and quality outcomes.
  • Thoroughly cognizant of metrics and organizes workload to meet them.
  • Consistently learns and applies codified state and federal regulations specific to particular contract(s).
  • Serve as backup to other nurses f or daily duties and assists with follow-up calls to facilities and Examinees as needed as well as other duties as assigned.
  • Opportunity to travel and assist on medical mobile events as either a site lead and/or RN as work or personal schedule permit.
  • May participate in interdepartmental project groups or task forces to integrate activities, communicate issues, obtain approvals, resolve problems, and maintain a specif ic level of knowledge pertaining to new
    developments, new task efforts, contract awards, and new policy requirements.
  • Supports marketing and sales objectives and efforts as requested.
  • Performs duties in a safe manner. Follows the corporate safety policy. Participates and supports safety meetings, training, and goals. Ensures safe operating conditions within an area of responsibility.
    Encourages co-workers to work safely. Identifies "close calls" and/or safety concerns to supervisory
    personnel. Maintains a clean and orderly work area.
  • Assists in the active implementation of company initiatives to ensure compliance with OSHA VPP, ISO, JCAHO, AAAHC, and other mandated regulations/standards.
  • May serve on the OSHA VPP, Safety, and Wellness Committees.

Qualifications/Knowledge Skills & Abilities:
  • 5-7 years of relevant experience.
  • Fully unencumbered nursing license to work in Washington DC required.
  • Proficiency with computer and common office equipment, as well as with MS Office products.
  • Must be able to multitask, be flexible, be organized, and have excellent oral and written communication skills as well as exceptional attention to detail.
  • Ability to work independently and prioritize a moderate workload with minimal supervision
  • Adaptability to schedule changes on an as-need basis
  • Must be eligible to work in the US
  • Must possess reliable transportation, have a clean driving record, and current automobile insurance.
  • Must be 18 years of age or older
  • Current CPR, BLS or ACLS

Disclaimer:
LifeHealth is an Equal Employment Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
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