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Medical Review Rn Jobs in Fresno, CA (NOW HIRING)

Trinityhealth

Peer Review Coordinator RN

Fresno, CA

$45.50 - $68.27/hr

The position will collaborate with the Chief Medical Officer, Chief Nursing Officer, Medical Staff ... as a Registered Nurse in the State of California is required. 3. Five (5) years of clinical ...

Trinity Health

Peer Review Coordinator RN

Fresno, CA · On-site

$45.50 - $68.27/hr

The position will collaborate with the Chief Medical Officer, Chief Nursing Officer, Medical Staff ... as a Registered Nurse in the State of California is required. 3. Five (5) years of clinical ...

Trinity Health

Peer Review Coordinator RN

Fresno, CA

$45.50 - $68.27/hr

The position will collaborate with the Chief Medical Officer, Chief Nursing Officer, Medical Staff ... as a Registered Nurse in the State of California is required. 3. Five (5) years of clinical ...

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All JobsMedical Review Rn JobsMedical Review Rn Jobs in Fresno, CA

Medical Review Rn information

See Fresno, CA salary details

$23

$44

$69

How much do medical review rn jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for medical review rn in Fresno, CA is $44.59, according to ZipRecruiter salary data. Most workers in this role earn between $34.13 and $52.98 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.

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 near Fresno, CA are hiring for Medical Review Rn jobs?

Cities near Fresno, CA with the most Medical Review Rn job openings:

Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in Fresno, CA as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 17% Part Time, and 6% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $92,757 per year, or $44.6 per hour.

Utilization Review Nurse (RN)

Madera Community Hospital

Madera, CA • On-site

Other

Re-posted 2 days ago

Job description

Utilization Review Nurse

Located in the heart of Central California, Madera Community Hospital is a General Acute Care, private, not-for-profit hospital dedicated to improving and maintaining the health and wellness of residents throughout the Central Valley. We are committed to identifying and serving our community's needs with compassion, concern, care and safety for every patient. Madera Community Hospital is a growing acute care facility seeking talented individuals with a drive to provide quality care and dedicated to making a difference in our community.

Position Summary: The Utilization Review Nurse assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, Nursing, patient and family who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.

Qualifications:

  • Minimum of 1–3 years of related acute care nursing experience and completion of an accredited nursing program required.
  • Experience with Meditech Electronic Health Record (EHR) system preferred.
  • Must have working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
  • Ability to maintain collaborative working relationships to ensure a positive and productive work environment.
  • Ability to plan and prioritize work with frequent interruptions.
  • Ability to provide exceptional customer service.
  • Effective verbal and written communication skills.
  • Knowledge and proficiency of hospital information technology applications.
  • Requires Current California Board of Nursing Registered Nurse License.
  • Current American Heart Association BCLS certificate required; ACLS certificate preferred.
  • CCM in Case Management preferred.

Madera Community Hospital provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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