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Medical Review Rn Jobs in Minnesota (NOW HIRING)

Ecumen

Registered Nurse RN

Medford, MN

$37 - $45/hr

Maintain up-to-date medical records and care plans; ensure timely assessments and proper ... For further information, please review the Know Your Rights notice from the Department of Labor.

Uniti Med

Travel Med Surg/ER Swing RN

Baudette, MN

$1K - $2K/wk

Uniti Med is seeking a travel nurse RN Med Surg for a travel nursing job in Baudette, Minnesota. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 36 ...

Ecumen

Registered Nurse, RN

Detroit Lakes, MN · On-site

$38 - $43/hr

Completes reviews/revises service agreements as needed and/or required. * Monitors and maintains ... Supervises medication practices and medical equipment being used in the building. Follows-up with ...

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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 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.

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.
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

Registered Nurse (RN) - MedSurg

Olmsted Medical

Rochester, MN • On-site

Part-time

Medical, Dental, Vision, Life

Posted 22 days ago

Job description

0.75 FTE - Day/Night Variable Shifts

Starting Wage - $40.60 - $55.82 (Based on Experience)

Offers for external candidates are generally made between the minimum and 3/4 point of the range, based on experience.

At Olmsted Medical Center, we value our employees and are committed to providing a comprehensive and competitive benefits package. To keep up with the evolving trends, Olmsted Medical Center offers the following for employees who are employed at a 0.5 FTE or higher.

  • Medical Insurance
  • Dental Insurance  
  • Vision Insurance
  • Basic Life Insurance
  • Tuition Reimbursement
  • Employer Paid Short-Term Disability and Long-Term Disability
  • Adoption Assistance Plan

Qualifications:

  • Completion of an accredited professional nursing program
  • Current Minnesota Registered Nurse license
  • BLS certification/ACLS certification within 90 days
  • One to three years nursing experience preferred
  • Special Care Unit only: PALS certification within 90 days

Job Responsibilities:

Practice of Professional Nursing includes but is not limited to:

  • Providing a comprehensive assessment of the health status of a patient through the collection, analysis, and synthesis of data used to establish a health statue baseline and plan of care. The RN also addresses changes in the patient condition.
  • Collaborating with the healthcare team to develop and coordinate an integrated plan or care.
  • Developing nursing interventions to be integrated into the plan of care.
  • Implementing nursing care through the execution of independent nursing actions.
  • Implementing interventions that are delegated, ordered, or prescribed by a licensed healthcare provider.
  • Delegating nursing tasks or assigning nursing activities to implement the plan of care.
  • Providing safe and effective nursing care.
  • Promoting a safe and therapeutic environment.
  • Advocating for the best interests of individual patients.
  • Evaluating responses to interventions and the effectiveness of the plan of care.
  • Collaborating and coordinating with other healthcare professional in the management and implementation of care within and across care settings and communities.
  • Providing health promotion, disease prevention, care coordination, and case finding.
  • Designing and implementing teaching plans based on patient need and evaluating teaching effectiveness.
  • Participating in the development of healthcare policies, procedures, and systems.
  • Is accountable for the quality of care delivered, recognizing the limits of knowledge and experience; addresses situations beyond the nurse’s competency; and performs at the level of education, knowledge, and skill ordinarily expected if an individual has completed an approved professional nursing education program.
  • Managing, supervising, and evaluating the practice of nursing.
  • Maintaining OMC Organization Competencies and Nursing Competencies pertinent to area of practice.
  • Managing information in accordance with state and federal regulations.
  • Communicating effectively.

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