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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.

Can I make $500,000 as a nurse?

Medical Review RNs typically do not earn $500,000 annually, as most nursing salaries are below that level. High earnings in nursing usually require advanced roles, specialized certifications, management positions, or work in high-paying industries or locations. Achieving such a salary may involve additional education, experience, and responsibilities beyond standard nursing roles.

What does a medical review RN do?

A Medical Review RN evaluates insurance claims, medical records, and provider documentation to determine coverage and compliance with policies. They ensure accurate assessment of medical necessity, often working with healthcare providers and insurance companies, and may require knowledge of medical coding and documentation standards.

How to make $300,000 as a nurse?

Medical Review RNs can increase their earnings by gaining specialized certifications, such as in case management or legal nurse consulting, and working in high-demand settings like telehealth or insurance companies. Advancing to senior or managerial roles, working overtime, or taking on consulting projects can also boost income toward $300,000 annually.

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.

How to make an extra 2000 a month as a nurse?

Medical Review RNs can increase their income by taking on additional freelance or per diem review assignments, working overtime, or obtaining specialized certifications to qualify for higher-paying roles. Developing expertise in specific medical areas or coding can also lead to higher-paying opportunities outside regular hours.

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 Pennsylvania are hiring for Medical Review Rn jobs? Cities in Pennsylvania with the most Medical Review Rn job openings:
Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Pennsylvania as of July 2026, with employment types broken down into 1% As Needed, 77% Full Time, 16% Part Time, and 6% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution.

Utilization Review RN

Healthcare Support Staffing

Philadelphia, PA

Other

Medical, Dental, Vision

Re-posted 17 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Evaluate clinical information submitted by providers against plan review criteria and benefit guidelines

Utilize clinical information to determine if criteria for medical necessity and benefit guidelines are met

Document pertinent case information for approvals and denials- refer cases failing to meet Interqual to Medical Director

Act as liaison to ensure services are provided in the least restrictive, most cost effective and clinically appropriate setting

ID and resolve problems that could interfere with provider's continuity and coordination of care of members- refer unresolved problems to the manager


Qualifications

Clear and active RN license in state of PA

Minimum AS in nursing

2 years' experience in acute care hospital AND 

2 years' experience in managed care, quality assurance or utilization review setting


Additional Information

Hours for this Position:

40 hours a week

M-F, daytime hours



Advantages of this Opportunity: 

Competitive salary, negotiable based on relevant experience

Benefits offered, Medical, Dental, and Vision

Fun and positive work environment

Right to Hire opportunity

Can start as early as next week    


Interested in being considered? 

If you are interested in applying to this position, please contact Steph Zymowski at 407-636-7030 ext.220  and click the Green I'm Interested Button to email your resume. 

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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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