ZipRecruiter

Log In

1

Medical Review Rn Jobs in California (NOW HIRING)

TotalMed RN

Travel Utilization Review RN

Irvine, CA · On-site

TotalMed RN is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job ... Properly document and submit medical records. * Communicate with Insurance companies to collaborate ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

... the medical record for the medical necessity, intensity of service and severity of illness ... Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

... medical record for the medical necessity, intensity of service and severity of illness ... Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience ...

GQR Global Markets

RN - Case Manager

Mission Viejo, CA · On-site

$2.0K - $2.1K/wk

Registered Nurse (RN) Facility: Estimated Pay: $2065.88 - $2160.88 Duration: 13 weeks Specialty ... Case Management/Utilization Review Shift: Day Benefits: * Day 1 Insurance * Cigna medical, MetLife ...

previous pagenext page

Showing results 21-40

All JobsMedical Review Rn JobsMedical Review Rn Jobs in California

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.

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.

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.

How to become a medical review RN?

To become a medical review RN, you need to earn a nursing license by completing an accredited nursing program and passing the NCLEX-RN exam. Additionally, gaining experience in clinical settings and obtaining certifications such as Certified Professional Coder (CPC) or specialized training in medical review can enhance qualifications for this role.

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 August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 12% Part Time, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

Travel Utilization Review RN

Irvine, CA • On-site

TotalMed RN
See more jobs at TotalMed RNexternal

Contractor

Medical, Dental, Vision, Retirement

Posted 7 days ago

Job description

TotalMed RN is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Irvine, California.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel

We're looking for RN Case managers for an immediate travel nurse opening in Irvine, CA. The right RN should have 1-2 years recent case management experience. Read below for more requirements. As a RN Case Manager, you'll work with a highly skilled team of professionals to advocate for patients, evaluate, plan, provide resources and facilitate communication with family members. You will be responsible for comprehensive coordination of short and long-term care for patients, with the goal of decreasing hospital stay lengths and reducing readmission rates to generate cost-effective outcomes.
As a Case Management Travel Nurse, you should be prepared to perform the following tasks:

  • Evaluate and assess new patients.
  • Create and update comprehensive short and long-term patient care plans.
  • Educate families and patients about resources and health care options.
  • Collaborate with other RNs, doctors and social workers.
  • Properly document and submit medical records.
  • Communicate with Insurance companies to collaborate or appeal decisions.
  • Improve financial status by analyzing results, monitoring variances, identifying trends and recommending actions to management.
Case Management Travel Nurses should be able to stand and walk for long periods of time, carry up to 10 pounds of weight, as well as bend, lean and stoop without difficulty. RN Case Managers should be able to manage a fluctuating caseload during times of high census and work efficiently in a collaborative environment. Because of the cooperative nature of this role, RN Case Managers should possess good oral and written communication abilities to communicate effectively with patients, families and co-workers.
Requirements*: BLS, 3 Years
* Additional certifications may be required before beginning an assignment.

TotalMed RN Job ID #1492775. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Case Manager - Case Mgr RN - Travel Nurse

About TotalMed RN

TotalMed is a Top Ten, travel nursing and healthcare staffing agency with the mission of igniting purpose in healthcare. The organization staffs nurses, therapists, pharmacists, and other clinicians of all specialties in all 50 states. They offer local and travel jobs and match caregivers with the right organization to assist both facilities and patients. As an organization, they focus on putting highly-skilled staff into facilities to ensure adequate staffing for a better patient experience.


TotalMed specializes in recruiting and placing healthcare professionals in travel, PRN, and permanent positions across the country in Nursing and Allied Health. Throughout 2020, the organization filled roles at even the most short-staffed facilities during the most challenging time in healthcare. By matching the right travel healthcare professional with the right organization, TotalMed continues to offer a lifeline to facilities and their patients.

Benefits
  • Weekly pay
  • Guaranteed Hours
  • Continuing Education
  • 401k retirement plan
  • Sick pay
  • Wellness and fitness programs
  • Referral bonus
  • Employee assistance programs
  • Medical benefits
  • Dental benefits
  • Vision benefits
  • Benefits start day 1

Apply