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Medical Review Rn Jobs in Ohio (NOW HIRING)

TNAA TotalMed RN

Travel RN Medical/Surgical

Geneva, OH · On-site

$1.7K - $2.3K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Geneva, Ohio. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 09/21/2026 * Duration: 13 weeks ...

TNAA TotalMed RN

Travel RN Medical/Surgical

Geneva, OH · On-site

$1.7K - $2.3K/wk

TNAA TotalMed RN is seeking a travel nurse RN Med Surg for a travel nursing job in Geneva, Ohio. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 09/28/2026 * Duration: 13 weeks ...

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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 Ohio are hiring for Medical Review Rn jobs?

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

Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Ohio as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 12% Part Time, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

RN / Utilization Review

TPF Nursing Agency

Middleburg Heights, OH • On-site

Other

Medical, Dental, Vision, Retirement

Re-posted 11 days ago

Job description

TPF Nursing welcomes you to our job board. Please review the job opportunity below:
Client: Southwest General Hospital Health Center
Location: Middleburg Heights OH
Shift: 5 x 8 Days
Start / End: Mon 7/20/26 - 10/17/26
Duration: 13 Weeks
Highlights

  • Shift: 8am-4:30pm
  • Minimum of five (5) years recent RN experience
  • Previous Case Management or Utilization Management Experience required
  • Previous experience with screening criteria Cerner, InterQual, and MCG Criteria, Standardized Templates required
  • Full-Time 40 hours per week, 5 (8) hour shifts 8a-4:30p, as well as every 3rd weekend
  • Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management)
  • Previous Care Management, Case Management or Utilization Management Experience
  • Experience with doing 30+ reviews a day
  • Previous experience with screening criteria including Cerner, InterQual, and MCG is required
  • Excellent critical thinking and communication skills
  • Strong computer skills
  • Current licensure by Ohio State Board of Nursing
  • ACM/CCM Certification helpful
  • Is candidate local to facility? Highly desired
If you have any questions, please feel free to call us directly at 212-219-2677 and ask for a recruiter. We encourage applicants and staff to ask questions, discuss potential / existing assignments, keep us informed about their needs and how we might help. Most clinical contracts are 13 weeks with a didactic and clinical orientation. These clinical opportunities are updated on a regular basis, so please come back if you don't see an opportunity that suits you.
Benefits available through agency:
  • Health Insurance
  • Dental Insurance
  • Vision Insurance
  • Safe Harbor and Retirement Savings Plan -401k
  • Weekly Pay
  • 24/7 On Call
  • Holiday OT
  • Sick Pay
  • FMLA
  • Joint Commission Certified

LT # 22836

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