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Medical Review Rn Jobs in California (NOW HIRING)

GQR Healthcare

Travel RN Case Manager

Simi Valley, CA · On-site

$2.5K - $2.6K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Simi ... Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed ...

GQR Healthcare

Travel Case Manager RN

Oakland, CA · On-site

$2.6K - $2.7K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Oakland ... Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed ...

GQR Healthcare

Travel Case Manager RN

Eureka, CA · On-site

$2.1K - $2.2K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Eureka ... Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed ...

GQR Healthcare

Travel RN Care Coordinator

Chico, CA · On-site

$2.7K - $2.8K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Chico ... Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed ...

GQR Healthcare

Travel RN Case Manager

Oakland, CA · On-site

$2.5K - $2.6K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Oakland ... Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed ...

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Medical Review Rn information

What is a Medical Review RN?

A Medical Review RN is a registered nurse who specializes in reviewing medical records and claims to ensure they meet established guidelines and standards. These nurses often work for insurance companies, government agencies, or healthcare organizations, evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. Their role may include determining medical necessity, performing utilization reviews, and supporting appeals or audits. They use their clinical knowledge to interpret complex medical information and collaborate with healthcare providers to support accurate decision-making.

Can I make $500,000 as a nurse?

Medical Review RNs typically do not earn $500,000 annually, as most nursing salaries are below that level. High earnings in nursing usually require advanced roles, specialized certifications, management positions, or work in high-paying industries or locations. Achieving such a salary may involve additional education, experience, and responsibilities beyond standard nursing roles.

What does a medical review RN do?

A Medical Review RN evaluates insurance claims, medical records, and provider documentation to determine coverage and compliance with policies. They ensure accurate assessment of medical necessity, often working with healthcare providers and insurance companies, and may require knowledge of medical coding and documentation standards.

How to make $300,000 as a nurse?

Medical Review RNs can increase their earnings by gaining specialized certifications, such as in case management or legal nurse consulting, and working in high-demand settings like telehealth or insurance companies. Advancing to senior or managerial roles, working overtime, or taking on consulting projects can also boost income toward $300,000 annually.

How does a Medical Review RN collaborate with other healthcare professionals during the review process?

A Medical Review RN often works closely with physicians, case managers, and insurance representatives to ensure that medical claims and treatment plans meet regulatory and clinical guidelines. Collaboration may involve participating in interdisciplinary meetings, discussing complex cases, and providing clinical expertise to support utilization management decisions. Effective communication and teamwork are essential, as you'll need to relay findings, request additional information, and sometimes clarify medical necessity with providers. This collaborative environment helps ensure quality care for patients while maintaining compliance with payer policies.

How to make an extra 2000 a month as a nurse?

Medical Review RNs can increase their income by taking on additional freelance or per diem review assignments, working overtime, or obtaining specialized certifications to qualify for higher-paying roles. Developing expertise in specific medical areas or coding can also lead to higher-paying opportunities outside regular hours.

What are the key skills and qualifications needed to thrive as a Medical Review RN, and why are they important?

To thrive as a Medical Review RN, you need a strong clinical background, critical thinking skills, and an active RN license, often supported by experience in case management or utilization review. Familiarity with medical coding, claims management software, and knowledge of regulatory guidelines such as Medicare and Medicaid are typically required. Strong attention to detail, excellent written communication, and the ability to work independently are essential soft skills for this role. These competencies ensure accurate and compliant medical record reviews, which are critical for proper claims adjudication and regulatory adherence.
What cities in California are hiring for Medical Review Rn jobs? Cities in California with the most Medical Review Rn job openings:
Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in California as of July 2026, with employment types broken down into 2% As Needed, 77% Full Time, 13% Part Time, and 8% Contract. Highlights an 94% In-person, 2% Hybrid, and 4% Remote job distribution.
Utilization Review RN (Hybrid)

Utilization Review RN (Hybrid)

Vivo HealthStaff

Daly City, CA • On-site

Full-time

Posted 16 days ago

Job description

Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan in San Francisco. It is a hybrid position with 1-2 days per week on-site required.

Collaborates with the physician, nurse case manager, social worker, and other members of the health care team to meet individualized patient outcomes. Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Ensures medical necessity determinations, service authorization and concurrent denials are managed effectively and financially responsibly.

Education

    • Valid RN license in State of California
    • Bachelor's degree in Nursing

Experience

      • Clinical experience in acute care setting Required
      • Experience with interqual and millimen Preferred

Licenses and Certifications

        • CPR - Cardiac Pulmonary Resuscitation CPR/BLS Preferred and
        • CCM - Certified Case Manager CCM Preferred and
        • ACMA Preferred

Knowledge, Skills, and Abilities

        • Verbal and written communication skills.
        • Basic computer skills.
        • Diagnostic and problem-solving skills.
        • Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
        • Actively participates in ongoing professional enrichment and educational opportunities. Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high quality, cost effective manner. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient, LOS insurance and discharge needs.
        • Collects quality improvement data in accordance with approved indicators. Recognizes potential problems and makes referrals to quality improvement, risk management, safety, infection control, and other departments as appropriate.
        • Confers and collaborates routinely with the physician advisor, division chiefs, and attending physicians to resolve problems regarding acuity and level of care.
        • Evaluates concurrent and retrospective denials for appeal opportunities. May generate appeal letters based on knowledge of clinical severity and intensity.
        • Identifies insurance information, obtains authorization, communicates with financial counseling and assigns appropriate length of stay for admission.
        • Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third party payers according to policies and procedures. Communicates utilization plans to case management team.
        • Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment for services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources.
        • Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services, staff meetings, orientation and formal educational offerings.
        • Demonstrates knowledge of the dynamics of abuse/neglect, including identification and reporting laws. Coordinates with investigating law enforcement, protection agencies, hospital security, risk management, and healthcare team. Demonstrates knowledge of community resources serving the high social risk populations.
        • Performs other duties as assigned.
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About Vivo HealthStaff

Sourced by ZipRecruiter

Vivo HealthStaff provides permanent recruitment services for both clinical and administrative positions in the healthcare sector. Over the past 2 years, our clients have seen a 98% retention rate with Vivo HealthStaff placements.

Industry

Health care and social assistance

Company size

11 - 50 Employees

Headquarters location

Dublin, CA, US

Year founded

2016

Social media

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