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Medical Review Rn Jobs in California (NOW HIRING)

Cynet Health

Utilization Review RN

Eureka, CA · On-site

$1.9K/wk

... Review RN responsible for concurrent reviews, medical necessity determinations, prior authorizations, continued stay reviews, and utilization management using InterQual criteria while ensuring ...

OU Health (Parent)

Utilization Review RN

Whittier, CA · On-site

$2.8K/wk

... Nursing Profession Registered Nurse Specialty Utilization Review Job ID 18027156 Job Title ... ensuring medical necessity, appropriate level of care, and compliance with CMS, EMTALA, and ...

Houston Methodist

Utilization Review RN

Cypress, CA

At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical ...

GLC On-The-Go

Travel Utilization Review RN

Apple Valley, CA · On-site

$1.6K - $1.8K/wk

Utilization Review * Discipline: RN * Start Date: 07/27/2026 * Duration: 13 weeks * 40 hours per week * Shift: 8 hours * Employment Type: Travel GLC is hiring: RN Case Management - Apple Valley, CA ...

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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 June 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

Utilization Review RN

Cynet Health

Eureka, CA • On-site

$1.9K/wk

Other

Posted 16 days ago

Job description

Details
Client Name
Providence Health and Services
Job Type
Travel
Offering
Nursing
Profession
Registered Nurse
Specialty
Utilization Review
Job ID
17979666
Job Title
Utilization Review RN
Weekly Pay
$1949.74
Shift Details
Shift
8 Hour Days
Scheduled Hours
40
Job Order Details
Start Date
04/06/2026
End Date
07/06/2026
Duration
13 Week(s)
Job Description
Remote Utilization Review RN responsible for concurrent reviews, medical necessity determinations, prior authorizations, continued stay reviews, and utilization management using InterQual criteria while ensuring compliance with CMS, Medicare regulations, and hospital guidelines in an acute care setting.
Client Details
City
Eureka
State
CA
Zip Code
95501
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About Cynet Health

Sourced by ZipRecruiter

Cynet Health is a TJC certified MBE and one of the fastest-growing healthcare staffing firms in the US providing Health Med and Health IT staffing and consulting services to countless hospitals, SNFs, clinics, labs, CROs, health & wellness centers, pharmacies, and other medical facilities across the United States. Headquartered in Sterling, Virginia, we are a certified Minority-Owned Business Enterprise and a recognized Diversity Supplier. Vision Our Vision is to be the most trusted and reliable provider for healthcare companies and medical facilities across the United States. Mission Our mission is to serve our healthcare customers with excellence and make a meaningful difference in the lives of patients and our communities.

Industry

Recruiting and staffing services

Company size

501 - 1,000 Employees

Headquarters location

Sterling, VA, US

Year founded

2015

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