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Medical Review Rn Jobs in Dallas, TX (NOW HIRING)

P1083

PRN Utilization Review RN - M-F Days

Dallas, TX · On-site

PRN Utilization Review RN - M-F DaysMust be available to work daytime hours (between 8am-6:30pm ... As a world-renowned medical and research center, we strive to provide the best possible care ...

U1088

CDI Quality Review RN

Dallas, TX · On-site

As a world-renowned medical and research center, we strive to provide the best possible care ... JOB SUMMARY The CDI Quality Review Nurse (QRN) will work under the direction of the Clinical ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: * This ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

You will perform frequent case reviews, check medical records and speak with care providers ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

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All JobsMedical Review Rn JobsMedical Review Rn Jobs in Dallas, TX

Medical Review Rn information

See Dallas, TX salary details

$23

$44

$69

How much do medical review rn jobs pay per hour?

As of Jul 28, 2026, the average hourly pay for medical review rn in Dallas, TX is $44.43, according to ZipRecruiter salary data. Most workers in this role earn between $33.99 and $52.79 per hour, depending on experience, location, and employer.

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 near Dallas, TX are hiring for Medical Review Rn jobs? Cities near Dallas, TX with the most Medical Review Rn job openings:
Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Dallas, TX as of July 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, and 6% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $92,414 per year, or $44.4 per hour.
Utilization Review Registered Nurse

Utilization Review Registered Nurse

TEXAS INSTITUTE FOR SURGERY

Dallas, TX • On-site

Full-time

Posted 20 days ago

Job description

The Utilization Review Registered Nurse is responsible for ensuring appropriate patient status, medical necessity, and payer compliance through prospective, concurrent, and retrospective review.
This role serves as the clinical lead for utilization management and a key contributor to denial prevention, partnering closely with Denial Management and Revenue Cycle teams to proactively identify, mitigate, and reduce denial risk. The role also collaborates closely with Case Management to align patient status, authorization, and progression of care with payer requirements.
Essential Duties and Responsibilities:
  1. Conduct admission and concurrent medical necessity reviews using InterQual or Milliman criteria.
  2. Ensure appropriate patient status designation, including inpatient versus observation level of care.
  3. Obtain, validate, and maintain payer authorizations and required notifications.
  4. Identify, escalate, and help mitigate cases at risk for denial.
  5. Collaborate with physicians to support accurate and complete clinical documentation.
  6. Serve as a liaison with payers during concurrent reviews, authorization inquiries, and peer-to-peer discussions.
  7. Partner with Denial Management and Revenue Cycle teams to identify denial trends and implement prevention strategies.
  8. Maintain accurate and timely documentation of utilization review activities.
  9. Ensure compliance with CMS, regulatory, and payer requirements.
  10. Perform daily census reviews to validate patient status, medical necessity, and authorization requirements.
  11. Prioritize high-risk cases, including extended observation stays, high-cost encounters, and incomplete or pending authorizations.
  12. Lead real-time denial prevention efforts through early identification of documentation, authorization, and medical necessity gaps.
  13. Prepare clinical information and support peer-to-peer reviews by aligning documentation with payer criteria.
  14. Provide timely feedback to physicians regarding documentation opportunities that may impact medical necessity determinations and reimbursement.
  15. Monitor patient progression against expected length of stay and evidence-based clinical criteria.
  16. Identify and escalate barriers that may impact payer approval, patient status, authorization, or reimbursement.
  17. Collaborate with Case Management to ensure alignment between payer requirements and discharge readiness without assuming discharge planning responsibilities.
  18. Participate in denial trend analysis, quality initiatives, and process improvement efforts.
  19. Support audit activities, including RAC, governmental, and commercial payer audits, and participate in pre-bill review processes as needed.

  • Education & Training:
    • Associate's degree in nursing required.
    • Bachelor's degree in nursing preferred.
  • Experience:
    • 3+ years of acute care experience required.
    • Experience in utilization review or case management preferred.
  • Licensure/Certification/Registration:
    • Current RN license in the state of Texas required
    • BLS required
    • Must possess and maintain a valid driver's license as employees may occasionally be required to operate a company vehicle. Reasonable accommodations may be provided as required by law.
  • Key Skills:
    • Comprehensive knowledge of CMS regulations, utilization management standards, and commercial payer requirements.
    • Strong communication, collaboration, critical thinking, and analytical skills.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable law.

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