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Medical Review Rn Jobs in Nevada (NOW HIRING)

Molina Healthcare

Medical Review Nurse (RN)

Reno, NV · Remote

$30.50 - $59.47/hr

... medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN) in Nevada. License must be active and unrestricted in state ...

Molina Healthcare

Medical Review Nurse (RN)

Reno, NV · Remote

$30.50 - $59.47/hr

... medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN) in Nevada. License must be active and unrestricted in state ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

... medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN) in Nevada. License must be active and unrestricted in state ...

Molina Healthcare

Medical Review Nurse (RN)

Henderson, NV · Remote

$30.50 - $59.47/hr

... medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN) in Nevada. License must be active and unrestricted in state ...

Molina Healthcare

Medical Review Nurse (RN)

Henderson, NV · Remote

$30.50 - $59.47/hr

... medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN) in Nevada. License must be active and unrestricted in state ...

Molina Healthcare

Medical Review Nurse (RN)

Mesquite, NV · Remote

$30.50 - $59.47/hr

... medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN) in Nevada. License must be active and unrestricted in state ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

... medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN) in Nevada. License must be active and unrestricted in state ...

Molina Healthcare

Medical Review Nurse (RN)

Las Vegas, NV · Remote

$30.50 - $59.47/hr

... medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN) in Nevada. License must be active and unrestricted in state ...

Molina Healthcare

Medical Review Nurse (RN)

Las Vegas, NV · Remote

$30.50 - $59.47/hr

... medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN) in Nevada. License must be active and unrestricted in state ...

P3 Health Partners

RN Concurrent Review

Las Vegas, NV

$90K - $100K/yr

RN Concurrent Review People. Passion. Purpose. At P3 Health Partners, our promise is to guide our ... The UM Nurse is responsible for compliance with the Medical Management Program Description of P3 ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works ...

P3 Health Partners

RN Concurrent Review

Henderson, NV · On-site

$90K - $100K/yr

We are looking for a RN Concurrent Review . If you are passionate about your work; eager to have ... The UM Nurse is responsible for compliance with the Medical Management Program Description of P3 ...

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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 Nevada as of May 2026, with employment types broken down into 1% As Needed, 86% Full Time, 7% Part Time, and 6% Contract. Highlights an 100% Physical job distribution.
Medical Review Nurse (RN)

Medical Review Nurse (RN)

Molina Healthcare

Reno, NV • Remote

$30.50 - $59.47/hr

Full-time

Posted 21 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

147th of 258 rated insurance

Job description

Job Description

Job Summary

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. 

 
Job Duties
  • Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. 
  • Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions.
  • Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. 
  • Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues.
  • Identifies and reports quality of care issues.
  • Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience.
  • Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings.                                                                   
  • Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. 
  • Supplies criteria supporting all recommendations for denial or modification of payment decisions.
  • Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. 
  • Provides training and support to clinical peers. 
  • Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols.
 
Job Qualifications
REQUIRED QUALIFICATIONS:
  • At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. 
  • Registered Nurse (RN) in Nevada. License must be active and unrestricted in state of practice. 
  • Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC).
  • Experience working within applicable state, federal, and third-party regulations.
  • Analytic, problem-solving, and decision-making skills.              
  • Organizational and time-management skills.
  • Attention to detail.
  • Critical-thinking and active listening skills. 
  • Common look proficiency.
  • Effective verbal and written communication skills.
  • Microsoft Office suite and applicable software program(s) proficiency.
PREFERRED QUALIFICATIONS:
  • Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications.
  • Utilization Management Experience
  • Experience with MCG, PEGA and/or Salesforce  
  • Billing and coding experience.
 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.  
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $30.5 - $59.47 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

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Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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