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Medical Review Rn Jobs in Massachusetts (NOW HIRING)

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · On-site

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive ...

TNAA TotalMed RN

Travel Med/Surg RN

Nantucket, MA · On-site

$2.4K - $3.3K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Nantucket, Massachusetts. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 10/12/2026 * Duration ...

TNAA TotalMed RN

Travel Med/Surg RN

Nantucket, MA · On-site

$2.4K - $3.3K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Nantucket, Massachusetts. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 10/05/2026 * Duration ...

Registered Nurse

Clinical Appeals RN

Boston, MA · On-site

$82.66/hr

... review of services. Works closely with managers and peers. If you currently reside in the state of ... Medical Plan options along with participation in a Health Spending Account or a Health Saving ...

Center for Human Development

Registered Nurse

Holyoke, MA · On-site

$85K/yr

The RN provides direct support to Persons in order to assess needs, participates in medical reviews, and provides counseling in areas of health and psycho-physiological well-being, and liaisons with ...

TNAA TotalMed RN

Travel RN Medical/Surgical

Boston, MA · On-site

$2.1K - $2.9K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Boston, Massachusetts. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 09/27/2026 * Duration: 13 ...

TNAA TotalMed RN

Travel Medical/Surgical RN

Boston, MA · On-site

TNAA TotalMed RN is seeking a travel nurse RN Float Med Surg for a travel nursing job in Boston, Massachusetts. & Requirements * Specialty: Float * Discipline: RN * Duration: 13 weeks * 36 hours per ...

TNAA TotalMed RN

Travel Med/Surg Telemetry RN

Salem, MA · On-site

$2.2K - $3.0K/wk

TNAA TotalMed RN is seeking a travel nurse RN Float Med Surg / Telemetry for a travel nursing job in Salem, Massachusetts. & Requirements * Specialty: Med Surg / Telemetry * Discipline: RN * Start ...

First Fertility

Registered Nurse

Reading, MA · On-site

$34 - $48/hr

Lead patient orientation and injection teaching sessions, and train to serve as the Reviewing RN ... Collaborate with physicians, medical assistants, and the broader clinical team to deliver safe ...

TNAA TotalMed RN

Travel Med/Surg Telemetry RN

Salem, MA · On-site

$2.2K - $3.0K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Salem, Massachusetts. & Requirements * Specialty: Med Surg / Telemetry * Discipline: RN * Duration: 13 ...

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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.

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.
Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Massachusetts 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.

Non-patient Care (utilization Review) Registered Nurse at Supplemental Health Care Boston, MA

Fairweather, LLC

Boston, MA • On-site

$79.17 - $86.72/hr

Other

Medical, Dental, Vision, Life, Retirement

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Non-patient Care (utilization Review) Registered Nurse job at Supplemental Health Care. Boston, MA.

Non-patient Care (utilization Review) RN Opportunity

Take your career to the next level with an assignment at one of New England's top healthcare destinations. Supplemental Health Care is hiring experienced Non-patient Care (utilization Review) RNs for contract roles at a leading Level 1 trauma center in Boston, Massachusetts. This Magnet-recognized teaching hospital is known for innovation, advanced care, and nursing excellence - an ideal place to grow your skills in a dynamic, high-acuity environment.

With 40+ years of experience connecting healthcare professionals to career-advancing opportunities, SHC is here to support you every step of the way.

Qualifications:
  • Active Massachusetts Registered Nurse License
  • American Heart Association BLS
  • Minimum 1 year of recent Non-patient Care (utilization Review) experience
  • Strong clinical and critical thinking skills
  • Commitment to high-quality patient care
Non-patient Care (utilization Review) Registered Nurse Contract Details:
  • $1,740 - $1,906 per week*
  • 13-week full time contract with possibility to extend
  • Shift Type shifts available
  • 40 hours per week
  • RN will be working at a Teaching Hospital with a great reputation

*Estimated weekly payment may include both taxable wages and tax-free reimbursements for meals, housing, and incidentals. Please speak with a recruiter for details.

What We Offer:
  • Full medical, dental, vision, life, and even pet insurance!
  • Round the clock support. No matter where you are or what time it is, Supplemental Health Care is standing by.
  • SHC's Share the Care referral program is the most dynamic, profitable referral program in the industry.
  • 401(k) Retirement Savings Program with a wide range of investment options.
  • Discounted and free online access to CEU courses through Supplemental University.

Supplemental Health Care is an Equal Opportunity Employer. All candidates, including veterans and those with disabilities, are encouraged to apply. SHC will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable local, state, or federal law. To learn more, visit

Supplemental Health Care

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