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Medical Review Rn Jobs in Washington (NOW HIRING)

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

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

VITAS Healthcare

Registered Nurse (RN)

Washington, DC · On-site

$45 - $47/hr

... medical, psychosocial, emotional and spiritual needs of hospice patients and families facing ... Manager reviews b. Registered Nurse, RN, responsible for attending orientation and regularly ...

VITAS Healthcare

Registered Nurse (RN)

Washington, DC

$45 - $47/hr

... medical, psychosocial, emotional and spiritual needs of hospice patients and families facing ... Manager reviews b. Registered Nurse, RN, responsible for attending orientation and regularly ...

VITAS Healthcare

Registered Nurse (RN)

Washington, DC

$45 - $47/hr

... medical, psychosocial, emotional and spiritual needs of hospice patients and families facing ... Manager reviews b. Registered Nurse, RN, responsible for attending orientation and regularly ...

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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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Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Washington as of May 2026, with employment types broken down into 1% As Needed, 86% Full Time, 8% Part Time, and 5% Contract. Highlights an 100% Physical job distribution.
Medical Review Manager

Medical Review Manager

Saratoga Medical Center

Catonsville, MD • On-site

Full-time

Posted 9 days ago

Job description

Saratoga Medical has an immediate opening for a Medical Review Manager for a program supporting the Centers for Medicare and Medicaid Services (CMS) in Catonsville, MD. The work hours are Monday to Friday from 8:30 am to 5:00 pm.

Qualifications:

* Board Certified in Nursing and licensed to practice nursing in the U.S. and a currently licensed RN

* Minimum of five years of experience practicing as an RN in either an acute hospital, skilled nursing facility, or an office/clinic-based medical practice

* Minimum of two years of experience of supervisory experience with Medicare's program coverage and payment rules

* Experience in MR processes of Medicare Administrative Contractors (MACs), CERT, Supplemental Medical Review Contractor (SMRC), or Railroad Retirement Board (RRB) MAC is preferred

Responsibilities:

*Supervise the Nurse Review staff

* Development, oversight, and implementation of the CERT accuracy medical review processes while supervising the medical review nurses

* Collaborate with the Program Manager, CMD, and other contract staff


Saratoga Medical Center, Inc. is an equal opportunity employer and will not discriminate in recruiting, hiring, training, promotion, transfer, discharge, compensation or any other term or condition of employment on the basis of race, religion, color, age (over age 39), sex, national origin, or on the basis of disability if the employee can perform the essential functions of the job, with a reasonable accommodation if necessary.