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Medical Review Rn Jobs in New Jersey (NOW HIRING)

Cooper University Hospital

CLINICAL REVIEW RN PRN

Camden, NJ · On-site

$37/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

CLINICAL REVIEW RN PRN Camden, NJ Job ID 67551 Job Type Per Diem Shift Day Specialty Other ... Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness ...

Aon

RN Medical Review Nurse (Hybrid)

Deptford Township, NJ · On-site

$77K - $94K/yr

  • Medical

  • Retirement

  • PTO

Excess Reinsurance is currently seeking a licensed RN to work in its Woodbury, NJ location to provide cost projections and underwriter support for the review of medical claims. This full-time ...

NFP Corp

RN Medical Review Nurse (Hybrid)

Woodbury, NJ · On-site

$77K - $94K/yr

  • Medical

  • Retirement

  • PTO

Excess Reinsurance is currently seeking a licensed RN to work in its Woodbury, NJ location to provide cost projections and underwriter support for the review of medical claims. This full-time ...

Aon

RN Medical Review Nurse (Hybrid)

Woodbury, NJ · On-site

$77K - $94K/yr

  • Medical

  • Retirement

  • PTO

Excess Reinsurance is currently seeking a licensed RN to work in its Woodbury, NJ location to provide cost projections and underwriter support for the review of medical claims. This full-time ...

New

NFP

RN Medical Review Nurse (Hybrid)

Deptford Township, NJ · On-site

$77K - $94K/yr

  • Medical

  • Retirement

  • PTO

Excess Reinsurance is currently seeking a licensed RN to work in its Woodbury, NJ location to provide cost projections and underwriter support for the review of medical claims. This full-time ...

New

NFP Corp

RN Medical Review Nurse (Hybrid)

Woodbury, NJ · On-site

$77K - $94K/yr

  • Medical

  • Retirement

  • PTO

Excess Reinsurance is currently seeking a licensed RN to work in its Woodbury, NJ location to provide cost projections and underwriter support for the review of medical claims. This full-time ...

NFP Corp

RN Medical Review Nurse (Hybrid)

Woodbury, NJ · On-site

$77K - $94K/yr

  • Medical

  • Retirement

  • PTO

Excess Reinsurance is currently seeking a licensed RN to work in its Woodbury, NJ location to provide cost projections and underwriter support for the review of medical claims. This full-time ...

Cooper University Hospital

Clinical Review RN PRN

Camden, NJ · On-site

$37 - $61/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness ... Bachelor's degree in Nursing preferred Current NJ-RN License required. Monday availability is ...

Cooper University Hospital

Clinical Review RN PRN

Camden, NJ · On-site

$61/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness ... RN License required. Special Requirements Monday availability is required. Salary Min ($)USD $37 ...

Cooper University Hospital

Clinical Review RN PRN

Camden, NJ · On-site

$61/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness ... NJ-RN License required. Special Requirements Monday availability is required. Salary Min ($) USD ...

Cooper University Hospital

Clinical Review RN PRN

Camden, NJ · On-site

$61/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness ... RN License required. Special Requirements Monday availability is required. Salary Min ($)USD $37 ...

GQR Global Markets

RN Case Manager

Morristown, NJ · On-site

$2.6K - $2.7K/wk

  • Medical

  • Dental

  • Vision

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Morristown ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

GQR Global Markets

RN - Case Manager

Morristown, NJ · On-site

$2.6K - $2.7K/wk

  • Medical

  • Dental

  • Vision

RN - Case Manager Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

GQR Healthcare

Travel RN Case Manager

Morristown, NJ · On-site

$2.6K - $2.7K/wk

  • Medical

  • Dental

  • Vision

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location ... Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed ...

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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 New Jersey are hiring for Medical Review Rn jobs?

Cities in New Jersey with the most Medical Review Rn job openings:

Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in New Jersey as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

CLINICAL REVIEW RN PRN

Cooper University Hospital

Camden, NJ • On-site

$37/hr

Other

Medical, Dental, Vision, Life, Retirement

This job post has expired today. Applications are no longer accepted.

Cooper University Health Care rating

7.5

Company rating: 7.5 out of 10

Based on 133 frontline employees who took The Breakroom Quiz

236th of 887 rated healthcare providers

Job description

CLINICAL REVIEW RN PRN Camden, NJ Job ID 67551 Job Type Per Diem Shift Day Specialty Other Professional
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About us

AtCooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.

Discover why Cooper University Health Care is the employer of choice in South Jersey.


Short Description
  • Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity. Performs utilization review in accordance with all state mandated regulations.
  • Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
  • Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
  • Completes documentation of review and denial processes in the EPIC Case Management Module. Responds to requests from the payer for all required information and treatment plans.
  • Reviews and validates physician's orders, reports progress and unusual occurrences on patients to the payer.

Experience Required

3-5 years of recent clinical experience, preferably in area of population specialty.

Experience in utilization management or review preferred.

Knowledge and understanding of disease protocols and clinical pathways for commercial and government payors. Familiarity with Interqual and Millimen guidelines and regulatory mandates preferred.

Strong communication (written and verbal) and critical thinking skills required. Professional and effective presentation skills required.


Education Requirements

Bachelor's degree in Nursing preferred


License/Certification Requirements

Current NJ-RN License required.


Special Requirements

Monday availability is required.

Hourly Rate Min $37
Hourly Rate Max $61

The New Jersey Pay Transparency Act requires disclosure of the pay range for this position.

A salary offer will vary based on the job role, candidate experience, qualifications, internal pay equity and market data.

Cooper University Health Care is an Equal Opportunity Employer and is committed to equal employment opportunity for all team members. All employment decisions are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, or any other status protected by law or regulation. To request reasonable accommodation, contact talent-acquisition@cooperhealth.edu

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