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Medical Review Rn Jobs in Michigan (NOW HIRING)

EPITEC

Registered Nurse-Review Analys

Detroit, MI · On-site

$36 - $39/hr

Type: Contract * Job #106555 Review Analyst-Registered Nurse Location: Remote but looking for ... Medical necessity * Appropriate length of stay * Intensity of service * Appropriate level of care ...

Epitec

Registered Nurse-Review Analys

Detroit, MI · On-site

$36 - $39/hr

Type: Contract * Job #106555 Review Analyst-Registered Nurse Location: Remote but looking for ... Medical necessity * Appropriate length of stay * Intensity of service * Appropriate level of care ...

ICONMA

Registered Nurse-Review Analys

Detroit, MI · On-site

Registered Nurse-Review Analyst Our client, a Health Insurance company, is looking for a Registered ... Contact appropriate medical and support personnel to identify and recommend alternative treatment ...

TNAA TotalMed RN

Travel Med Tele RN

Iron Mountain, MI · On-site

$1.8K - $2.5K/wk

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

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All JobsMedical Review Rn JobsMedical Review Rn Jobs in Michigan

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.

Registered Nurse-Review Analys

EPITEC

Detroit, MI • On-site

$36 - $39/hr

Other

Posted 19 days ago

Job description

  • Location: Detroit, Michigan
  • Type: Contract
  • Job #106555
Review Analyst-Registered Nurse
Location:
Remote but looking for candidates in MI-MUST HAVE A MI NURSING LICENSE
Schedule:
Monday-Friday
Type:
W2 Contract
Duration:
Long term on-going contract
Pay Rate:
$36-$39 an hour
Work Location
  • Remote position
  • Contractor will be required to come onsite for one day of training to:
    • Receive their company laptop
    • Attend in-person onboarding/training
  • Note: Onsite requirements could change in the future if directed by executive leadership.
Position Summary
Responsible for performing prospective, concurrent, and retrospective utilization reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure:
  • Medical necessity
  • Appropriate length of stay
  • Intensity of service
  • Appropriate level of care
Additional responsibilities include:
  • Reviewing appeal requests submitted by providers, facilities, and members
  • Developing care plans as needed
  • Coordinating care across the healthcare continuum
  • Conducting member outreach and assessments
Required Qualifications
  • Registered Nurse (RN) with a current, unrestricted Michigan RN license
  • 2 to 4 years of clinical experience, which may include:
    • Acute patient care
    • Discharge planning
    • Case management
    • Utilization review
  • Strong clinical knowledge of patient care and healthcare delivery processes
  • Above-average computer skills, including Microsoft Office
Preferred Qualifications
  • Bachelor's degree in Nursing, Allied Health, Business, or a related field
  • 1+ year of experience in a health insurance plan or managed care environment
  • Clinical experience in:
    • Intensive Care Unit (ICU)
    • Emergency Room (ER)
    • Medical-Surgical Unit
  • Prior utilization management experience
  • Case Management Certification (depending on department assignment)

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