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Medical Review Rn Jobs in Minnesota (NOW HIRING)

ISHE

IBR Clinical Review RN

Plymouth, MN · On-site

$80 - $100/hr

Complete focused review of medical records to evaluate clinical course of care as applicable ... Active and unrestricted RN license OR LPN in the state of residence * 2+ years of clinical ...

TNAA TotalMed RN

Travel Med Surg Neuro RN

Minneapolis, MN · On-site

$2.1K - $2.8K/wk

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

TNAA TotalMed RN

Travel Nurse RN - Med Surg

Grand Marais, MN · On-site

$2.0K - $2.7K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Grand Marais, Minnesota. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: ASAP * 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 Minnesota are hiring for Medical Review Rn jobs?

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

Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Minnesota as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 11% Part Time, and 9% Contract. Highlights an 87% Physical, 1% Hybrid, and 12% Remote job distribution.

Medical Review Nurse

ST CROIX HOSPICE LLC

Mendota Heights, MN • On-site, Remote

Full-time

Posted 17 days ago

St. Croix Hospice rating

8.5

Company rating: 8.5 out of 10

Based on 33 frontline employees who took The Breakroom Quiz

4th of 47 rated hospices

Job description

Work Where You Matter!
At St. Croix Hospice we guide patients and families through the end-of-life journey. Through compassionate care, we focus on our patient's quality of life, empowering them to make the most of their time with dignity, comfort and respect. If you are ready to be part of an extraordinary team of caregivers, then come work where you matter.
Medical Review Nurse
Position Overview
The Medical Review Nurse is an experienced nurse responsible for the monitoring, implementation and evaluation of processes and programs to ensure they meet regulatory, accreditation and standards of practice.
Essential Functions and Skills
  • Responsible for the implementation and monitoring of the organization's quality assessment performance improvement (QAPI) program.
    • Monitors and measures activities related to QAPI as assigned.
    • Implements quality improvement activities utilizing continuous quality improvement principles and methodologies.
    • Implements established schedule for clinical record review and data collection.
    • Compiles, trends, and reports quality data in the following areas: patient care, safety, risk management, infection control, outcomes, and customer satisfaction.
    • Works collaboratively with nursing department to assure documentation is complete and consistent with care and reflects regulatory/legal requirements.
  • Responsible for implementing processes to monitor and evaluate safety, risk management and infection control programs.
    • Implements monitoring activities for safety, risk management, and infection control.
    • Assists with mandatory in-service programs on OSHA regulations for safety and infection control as requested.
    • Acts as resource to staff in identifying safety and risk management issues for patients and staff.
    • Reviews all incident reports for completeness, risk, standard of care determination and appropriate follow-up. Trends data and makes recommendations related to trends identified.
    • Maintains current knowledge related to home care safety and infection control standards.
  • Monitor organization compliance with regulatory and accreditation standards.
    • Maintains current knowledge related to Medicare Conditions of Participation and the Community Health Accreditation Program's (CHAP) standards to ensure that the organization is compliant with state, federal and accreditation guidelines.
    • Participates in review of policies and procedures and makes recommendations for policy changes to the Director of Quality Assurance.
    • Acts as a resource to the clinical team regarding standards, policies, and regulations.
  • Acts as a clinical resource to staff.
    • Maintains updated nursing knowledge and skills.
    • Assists with patient visits as needed.
  • Promote self-growth and collegial relationships with others in the home care industry.
    • Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal and professional networks and participating in professional organizations or societies.
  • Reviews Medical Records to ensure standards and compliance are being met across the organization.
  • Reviews live discharges to ensure appropriateness and compliance.
  • Completes audits as required by survey or self- identified to ensure compliance in medical records.
  • Performs other duties as assigned.

Requirements/Qualifications
  • Must have a current Registered Nurse (RN) license in state(s) of practice.
  • 2+ years of Nursing experience.
  • Nurses holding a multistate license can practice in other states without obtaining additional licenses while maintaining their Registered Nurse (RN) license in their primary state of residence (PSOR). Minnesota, Michigan, and Illinois are not in the Nursing Licensure Compact.
  • Graduate of an accredited school of professional nursing.
  • If Driving: Valid State Driver's License, access to an automobile in good working order, automobile insurance in accordance with state and organizational requirements, and an acceptable driving record required.
  • Ability to pass DHS background study

Physical Requirements
The physical requirements described are representative of those that must be met to successfully perform the essential responsibilities of this position. Reasonable accommodation may be made.
  • Pushing/Pulling and Lifting/carrying up to 30 pounds. Occasionally up to 50 pounds.
  • Prolonged periods sitting at a desk and working on a computer.
  • Ability to adapt to a variety of work conditions to ensure the highest quality of patient care in a home setting.
  • May be exposed to infections and contagious diseases. Contact with patients under wide variety of circumstances. May be exposed to/occasionally exposed to patient elements. Subject to varying and unpredictable situations. Travel required. OSHA exposure category: Category I - Position includes tasks that involve exposure to blood, body fluids, tissues. Category II - Position includes tasks that involve no exposure to blood, body fluids, tissues, but employment may require unplanned Category I tasks. Category III - Position includes tasks that involve no exposure to blood, body fluids, tissues; would not be required to perform Category I tasks.

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