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Medical Review Rn Jobs in Tennessee (NOW HIRING)

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

Registered Nurse responsible for collaborating with healthcare providers, members, and business ... Medical necessity reviews may include: drugs and biologics, inpatient admissions, outpatient ...

Mindlance

Utilization Review Nurse

Nashville, TN

Medical necessity reviews may include: drugs and biologics, inpatient admissions, outpatient ... RN license. Multi-State License Preferred • Bachelor's degree in nursing or health-care related ...

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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 Tennessee as of May 2026, with employment types broken down into 1% As Needed, 87% Full Time, 6% Part Time, 5% Contract, and 1% Nights. Highlights an 100% Physical job distribution.
Utilization Review RN

Utilization Review RN

Healthcare Support Staffing

Brentwood, TN

Other

Medical, Dental, Vision

Posted 15 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

Job Title: Utilization Review RN

Are you an experienced Registered Nurse with Utilization Review experience professional looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!


Position Summary:

As the Utilization Review RN, you would be responsible for telephonically reviewing medical information in order to determine medical necessity of continued stay according to review standards. 


Hours for this Position: Monday-Friday 8:00am-5:00pm


Advantages of this Opportunity:

  • Competitive salary, negotiable based on experience
  • Benefits offered, Medical, Dental, and Vision
  • Fun and positive work environment
  • Weekly deposit options


More Insight of Daily Responsibilities: 

  • Ensures that services provided to eligible members are within benefit plan and appropriate contracted providers are being utilized
  • Determines medical necessity and length of stay based on the consistent application of CMS criteria
  • Assesses and coordinates simple discharge planning
  • Identifies quality of care issues



Qualifications

What We Look For:

  • RN license in the state of TN
  • Bachelor's Degree in related field
  • 2+ years of experience in UM, UR, pre-authorization, concurrent review, discharge planning and/or skilled nursing


Additional Information
Want More Information?
Interested in hearing more about this great opportunity? Reach out to Amanda Hammer at ahammer @healthcaresupport.com or click apply for additional details. 


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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

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