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Medical Review Rn Jobs in Michigan (NOW HIRING)

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Utilization Review Registered Nurse

Southfield, MI · On-site

$60 - $80/hr

Registered Nurse in State of MI with unencumbered license, BSN preferred; Minimum 2 years' experience in a managed care environment, preferably in a utilization related role. * Must have one year of ...

TNAA TotalMed RN

Travel Nurse RN - Med Surg

Saint Joseph, MI · On-site

$1.9K - $2.5K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Saint Joseph, Michigan. & Requirements * Specialty: Med Surg * Discipline: RN * Duration: 13 weeks * 40 hours per ...

TNAA TotalMed RN

Travel Nurse RN - Med Surg

Saint Joseph, MI · On-site

$1.9K - $2.5K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Saint Joseph, Michigan. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 09/08/2026 * Duration ...

TNAA TotalMed RN

Travel Nurse RN - Med Surg

Saint Joseph, MI · On-site

$1.9K - $2.5K/wk

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

TNAA TotalMed RN

Travel Nurse RN - Med Surg

Saint Joseph, MI · On-site

$1.9K - $2.5K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Saint Joseph, Michigan. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 09/08/2026 * Duration ...

TNAA TotalMed RN

Travel Nurse RN - Med Surg

Saint Joseph, MI · On-site

$1.9K - $2.5K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Saint Joseph, Michigan. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 09/08/2026 * Duration ...

TNAA TotalMed RN

Travel Nurse RN - Med Surg

Saint Joseph, MI · On-site

$1.9K - $2.5K/wk

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

TNAA TotalMed RN

Travel Nurse RN - Med Surg

Saint Joseph, MI · On-site

$1.9K - $2.5K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Saint Joseph, Michigan. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 09/08/2026 * Duration ...

TNAA TotalMed RN

Travel Med Surg RN

Marquette, MI · On-site

$1.9K - $2.6K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Marquette, Michigan. & Requirements * Specialty: Med Surg / Telemetry * Discipline: RN * Start Date: 09 ...

TNAA TotalMed RN

Travel Med Surg RN

Marquette, MI · On-site

$1.9K - $2.6K/wk

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

TNAA TotalMed RN

Travel Med Surg RN

Marshall, MI · On-site

$1.9K - $2.6K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Marshall, Michigan. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 10/05/2026 * Duration: 13 ...

TNAA TotalMed RN

Travel Med Surg RN

Petoskey, MI · On-site

$1.9K - $2.6K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Petoskey, Michigan. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 09/21/2026 * Duration: 13 ...

TNAA TotalMed RN

Travel Med Surg Tele RN

Muskegon, MI · On-site

$1.8K - $2.4K/wk

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

TNAA TotalMed RN

Travel Med Surg Tele RN

Muskegon, MI · On-site

$1.8K - $2.4K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Muskegon, Michigan. & 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.

What cities in Michigan are hiring for Medical Review Rn jobs?

Cities in Michigan with the most Medical Review Rn job openings:

Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Michigan as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Utilization Review- RN

Healthcare Support Staffing

Troy, MI • On-site

Full-time

Re-posted 11 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines


Provider appeals and Utilization reviews and assist with Denial Letters 


Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.

Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.

Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. 

Qualifications

Must be an RN 

Utilization Review background in either Managed Care of Provider environment (at least one year) 

Interqual experience 

Other basic computer skills necessary: Microsoft Office, Data Entry, etc. 

Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.

Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.

Additional Information

Are you an experienced RN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career In Nursing by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the RN position for you!

If you are interested, reach out to me (Krishna) at 321-574-6926

The greatest compliment to our business is a referral.If you know of someone looking for a new opportunity, please pass along my contact information!


Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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