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Medical Review Rn Jobs in Virginia (NOW HIRING)

Peraton

Medical Review Nurse- Medicare

Reston, VA · On-site

$66K - $106K/yr

Experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. * Current nursing license. Active license ...

Peraton

Medical Review Nurse- Medicare

Herndon, VA · On-site

$66K - $106K/yr

Experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. * Current nursing license. Active license ...

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

GQR Global Markets

RN Case Manager

Williamsburg, VA · On-site

$1.9K - $1.9K/wk

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

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Peraton

Nurse Reviewer - Medicaid

Reston, VA · On-site

$66K - $106K/yr

At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. * Current/Active ...

Peraton

Nurse Reviewer - Medicaid

Herndon, VA · On-site

$66K - $106K/yr

At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. * Current/Active ...

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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 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 August 2026, with employment types broken down into 89% Full Time, and 11% Part Time. Highlights an 100% In-person job distribution.

Registered Nurse - Medical Review Specialist

Hospitality Spotlight

Springfield, VA • On-site

$45 - $50/hr

Full-time

Re-posted 10 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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