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Medical Review Rn Jobs in Michigan (NOW HIRING)

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RN-Clinical Review Analyst

Detroit, MI · On-site

$33 - $34/hr

... RN license. You will perform prospective, concurrent and retrospective review of inpatient ... Clinical experience in ICU, ER, or medical surgical unit preferred * Prefer utilization management ...

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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.
What are popular job titles related to Medical Review Rn jobs in Michigan? For Medical Review Rn jobs in Michigan, the most frequently searched job titles are:
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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 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.
Registered Nurse Review Analyst

Registered Nurse Review Analyst

Strategic Staffing Solutions

Detroit, MI • On-site

$36/hr

Other

Posted 4 days ago

Job description

Job Description Title: Medicare Advantage RN Review Analyst Location: Detroit, MI (Remote - Must be local to Michigan) Duration: 12+ Months Role Type: W2 Contract role Max Pay Rate: $36/HR Schedule: Monday - Friday 9-5 SUMMARY Responsible for the approval or rejection of claims and/or benefit interpretation. May be required to enter or reference data via PC and/or Clinical Review Team terminal. REQUIREMENTS Registered Nurse with current Michigan Registered Nurse License.

Associate degree or nursing diploma required, bachelor's degree preferred. Two (2) years RN patient care experience. Triage, case management and/or rehabilitation experience preferred.

Medicare Advantage Part B experience a plus. Expertise in the use of medical terminology. Finely honed critical thinking skills are a must.

Knowledge of CPT/HCPCS coding and Medicare regulations desirable. CERTIFICATES, LICENSES, REGISTRATIONS Current unrestricted state of Michigan registered nurse license required. *Beware of scams.

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