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Medical Review Rn Jobs in Virginia (NOW HIRING)

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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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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 May 2026, with employment types broken down into 1% As Needed, 86% Full Time, 7% Part Time, and 6% Contract. Highlights an 100% Physical job distribution.
Registered Nurse (RN)

Registered Nurse (RN)

Blue Ridge Medical Center

Appomattox, VA

Full-time

Posted 17 days ago

Job description

Sign-On Bonus to Qualified Full-Time Candidate

Job Summary:

The Registered Nurse will provide clinical support to the provider as needed and provide direct nursing care to patients. As a collaborative team member, the RN contributes to the smooth operation of the clinic including administrative support and operational efficiency. This role may involve assignments at satellite locations as needed. The RN is expected to demonstrate a sincere dedication and loyalty to the mission, vision, and core values of BRMC. Primary responsibilities will be patient flow, including:

Responsibilities:

  1. Provides direct routine nursing care to patients and clinical assistance to provider according to provider’s instructions. As well as documenting all patient care provided in the EMR. This including nurse visits for blood pressure readings, medicine reviews, maintenance injections etc.
  2. Provides pre- and post-procedural nursing care to patients including administration of medication, point of care lab tests, venipuncture, EKGs, vision and hearing screens and assessment of patient’s status and development.
  3. Collects, labels and prepares specimens for lab, ensuring that the specimen is labeled in front of the patient and that all patients with each encounter are identified using the two patient identifiers of full name and date of birth.
  4. Provides patient specific education and communicates lab, x-ray, and test results with patients.
  5. Assists with patient triage to assess patient needs to make decisions about appropriate levels of care.
  6. Complete Transitional Care Management per protocols (transition of care when patient has been discharged from hospital or facility)
  7. Provides medicine reviews during office visits as well as updates to medical history, surgical history, allergy updates and social history along with assisting the provider to address specialized alerts set-up in the EMR (i.e. Cancer screenings, eye exams, PHQ-9 assessments, immunizations, labs that are due, etc.).
  8. Assists with routine office duties to include ordering medical supplies, maintaining appropriate inventory, scheduling patients, answering telephones, keeping environment need and orderly etc.
  9. Participates in performance improvement activities in accordance with applicable standards.
  10. Performs other necessary duties as assigned by the Director of Nursing/Clinical Nurse Manager/CMO to meet the goal of providing quality health care services.

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