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Medical Review Rn Jobs in Michigan (NOW HIRING)

Bestica Healthcare

RN - Utilization Review

Lansing, MI · On-site

Utilization Review Rn Travel Position We at Bestica believe our success is a direct result of hard work and outstanding employee dedication. Our environment is dynamic, friendly, and collaborative.

New

GQR

RN - Case Manager

Detroit, MI

$2.01K - $2.10K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Detroit ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

New

GQR

RN - Case Manager

Detroit, MI

$2.01K - $2.10K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Detroit ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

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Medical Review Rn information

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 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 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 to become a medical review nurse?

To become a medical review nurse, one must typically earn a nursing license by completing an accredited nursing program and passing the NCLEX-RN exam. Experience in clinical nursing and knowledge of medical coding, documentation, and healthcare regulations are also important, and some roles may require certification in case management or utilization review.
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Infographic showing various Medical Review Rn job openings in Michigan as of May 2026, with employment types broken down into 87% Full Time, and 13% Part Time. Highlights an 93% In-person, and 7% Remote job distribution.

RN - Utilization Review

Bestica Healthcare

Lansing, MI

Other

Posted 2 days ago

Job description

Utilization Review Rn Travel Position

We at Bestica believe our success is a direct result of hard work and outstanding employee dedication. Our environment is dynamic, friendly, and collaborative. We foster a positive culture, where innovation and synergy are encouraged to build our workplace into a community of like-minded, passionate people. Bestica is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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