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Medical Review Rn Jobs in Florida (NOW HIRING)

RN Cancer Guides

Oncology Nurse Advocate

Pensacola, FL · On-site

Interview patients and their loved ones to identify issues relating to their medical care * Assist ... Current Florida RN or NP Preferred: BSN or MSN, Case Management Certification, utilization review ...

RN Cancer Guides

Oncology Nurse Advocate

Bradenton, FL · On-site

Interview patients and their loved ones to identify issues relating to their medical care * Assist ... Current Florida RN or NP Preferred: BSN or MSN, Case Management Certification, utilization review ...

RN Cancer Guides

Oncology Nurse Advocate

Inverness, FL · On-site

Interview patients and their loved ones to identify issues relating to their medical care * Assist ... Current Florida RN or NP Preferred: BSN or MSN, Case Management Certification, utilization review ...

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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 Florida are hiring for Medical Review Rn jobs? Cities in Florida with the most Medical Review Rn job openings:
Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Florida as of June 2026, with employment types broken down into 1% As Needed, 45% Full Time, 40% Part Time, 13% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.
Pool Utilization Review Registered Nurse, Case Management, Per Diem, Shift Varies (Rotating Weeke...

Pool Utilization Review Registered Nurse, Case Management, Per Diem, Shift Varies (Rotating Weeke...

Baptist Health South Florida

Boca Raton, FL

$47/hr

Other

Posted 9 days ago

Baptist Health South Florida rating

8.0

Company rating: 8.0 out of 10

Based on 97 frontline employees who took The Breakroom Quiz

1st of 23 rated health and beauty retailers

Job description

The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical, financial and resource utilization. Coordinates with healthcare Team for optimal efficient patient outcomes, while decreasing length of stay and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention and coordination to decrease avoidable delays denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry, Facilitates communication between payers, review agencies and healthcare team, Identify delays in treatment or inappropriate utilization and serves as a resource, Coordinates communication with physicians, Identify opportunities for expedited appeals and collaborates resolve payer issues and ensures, maintains effective communication with Revenue Cycle Departments.Estimated pay range for this position is $47.00 / hour depending on shift as applicable.

Degrees:

  • Associates.

Licenses & Certifications:

  • Registered Nurse.

Additional Qualifications:

  • RNs hired prior to 2/2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN; however, required to complete the BSN within 3 years of hire.
  • 3 years of hospital clinical experience preferred.
  • Excellent written, interpersonal communication and negotiation skills.
  • Strong critical thinking skills and the ability to perform clinical chart review abstract information efficiently.
  • Strong analytical, data management and computer skills.
  • Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
  • Current working knowledge of payer and managed care reimbursement preferred.
  • Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families.
  • Knowledgeable in local, state, and federal legislation and regulations, and ability to tolerate high volume production standards.

Minimum Required Experience: .

  • BSN Required 
  • 3 years of Nursing experience with 1 year of Hospital or Payor Utilization Review experience required 
  • MCG Specialist Certification ISC/HRC required within 12 months of job entry date.

What Baptist Health South Florida employees say

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Benefits

Hours and flexibility

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About Baptist Health South Florida

Sourced by ZipRecruiter

Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 27,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World's Most Ethical Companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Miami, FL, US

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