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Medical Review Rn Jobs in Virginia (NOW HIRING)

Serco

Medical Review Manager

Richmond, VA · On-site

Graduate from an accredited Registered Nurse (RN) school with active state licensure * 4 years in a ... Expertise with determining medical review responses on medical review decisions based on Medicare ...

New

Lifehealth LLC

RN - Nurse Support

Springfield, VA · On-site

$51.77/hr

Review the medical questionnaire following protocols, using medical guidelines and their medical ... Registered professional nurse must possess an unencumbered Registered Nurse license in the State of

LifeHealth

RN - Nurse Support

Springfield, VA

Review the medical questionnaire following protocols, using medical guidelines and their medical ... Registered professional nurse must possess an unencumbered Registered Nurse license in the State of

LifeHealth

RN - Nurse Support

Springfield, VA · On-site

Review the medical questionnaire following protocols, using medical guidelines and their medical ... Registered professional nurse must possess an unencumbered Registered Nurse license in the State of

Lifepoint Health

RN Case Manager

Danville, VA · On-site

As RN Case Managerjoining our team, you are embracing a vital mission dedicated to making ... Works with physicians to conduct peer review with payer medical director when indicated. * Ensures ...

LifePoint Health

RN Case Manager

Danville, VA · On-site

RN Case Manager Schedule: Monday-Friday usually 8-hour shifts Current call matrix is rotating call ... Works with physicians to conduct peer review with payer medical director when indicated. * Ensures ...

Lifepoint Health

RN Case Manager

Danville, VA · On-site

As RN Case Manager joining our team, you are embracing a vital mission dedicated to making ... Works with physicians to conduct peer review with payer medical director when indicated. * Ensures ...

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All JobsMedical Review Rn JobsMedical Review Rn Jobs in Virginia

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 Virginia are hiring for Medical Review Rn jobs? Cities in Virginia with the most Medical Review Rn job openings:
Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Virginia as of June 2026, with employment types broken down into 1% As Needed, 42% Full Time, 36% Part Time, 20% Contract, and 1% Nights. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution.

Registered Nurse - Medical Review Specialist

Hospitality Spotlight

Springfield, VA • On-site

$45 - $50/hr

Full-time

Posted 23 days ago

Job description


Registered Nurse - Medical Review Specialist
A Hospitality Spotlight client supporting a federal agency is seeking a Registered Nurse to assist with medical case reviews and occupational health assessments. This role plays an important part in reviewing employee medical information and supporting workforce readiness determinations.
The position is based in Springfield, Virginia, with opportunities for a hybrid work arrangement after required training and clearance processes are completed.
The Work
  • Review employee-submitted electronic medical questionnaires and supporting documentation
  • Evaluate medical histories and health records using established medical guidelines and review protocols
  • Identify cases requiring additional medical information or clarification
  • Communicate with employees regarding medical documentation and follow-up requirements
  • Review records received from healthcare providers and determine next steps based on established criteria
  • Document findings, recommendations, and case activity within electronic record systems
  • Support fitness-for-duty evaluations and leave-related medical reviews as needed
  • Assist with medical documentation related to employee accommodation requests and administrative cases
  • Maintain confidentiality while handling protected health information and sensitive records
  • Provide exceptional service and communication throughout the review process
  • Contribute ideas that improve workflow efficiency and case review processes
  • Perform additional duties as assigned

What You've Done
  • Hold an active, unrestricted Registered Nurse license in Virginia
  • Bachelor of Science in Nursing (BSN) required. Master's degree preferred
  • Minimum of 3 years of occupational health, employee health, case management, or related nursing experience preferred
  • U.S. Citizenship required
  • Experience reviewing medical documentation and applying clinical judgment to case evaluations
  • Strong understanding of medical terminology, treatment plans, and common health conditions
  • Experience maintaining confidential medical information and regulatory compliance standards
  • Ability to obtain and maintain required federal background investigation and security clearance requirements

What Sets You Apart
  • Strong analytical and critical-thinking skills
  • Exceptional attention to detail and documentation accuracy
  • Ability to interpret medical information and apply established review guidelines
  • Excellent verbal and written communication skills
  • Comfortable working independently while managing a high-volume workload
  • Strong organizational and case management abilities
  • Experience utilizing electronic medical record systems and case management platforms
  • Ability to prioritize tasks and meet established timelines
  • Proficiency with Microsoft Office and computer-based systems
  • Physical Requirements
  • Position requires periods of standing and walking throughout the workday.

Location
  • Springfield, VA
  • Hybrid work opportunity available following successful completion of onboarding, background investigation, and security requirements.

Compensation
  • Hourly rate of $45.00 - $50.00

If you're looking for a meaningful nursing opportunity that combines clinical knowledge, case review, and federal program support, we'd love to connect.
Submit your resume to learn more.
We look forward to connecting and shining our spotlight on you.
- Hospitality Spotlight Team

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