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

GQR

RN - Case Manager

Mission Viejo, CA

$1.95K - $2.04K/wk

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

GQR

RN - Case Manager

Redlands, CA

$2.61K - $2.70K/wk

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

Cynet Health

RN - Case Manager

Irvine, CA

Case Manager RN Job Type: Travel Profession: Registered Nurse Specialty: Case Management Duration ... Stay Reviews, UR Medical Necessity, UR Retrospective Review, CPT Coding and Billing, HIPAA ...

Cynet Health

RN - Case Manager

Irvine, CA

Case Manager RN Job Type: Travel Profession: Registered Nurse Specialty: Case Management Duration ... Stay Reviews, UR Medical Necessity, UR Retrospective Review, CPT Coding and Billing, HIPAA ...

GQR Healthcare

Travel RN Case Manager

Mission Viejo, CA

$2.07K - $2.16K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mission ... Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed ...

GQR Healthcare

Travel RN Case Manager

Mission Viejo, CA

$1.95K - $2.04K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mission ... Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed ...

GQR Healthcare

Travel ED Case Manager RN

Redlands, CA

$2.61K - $2.70K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location ... Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed ...

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Medical Review Rn information

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How much do medical review rn jobs pay per hour?

As of May 31, 2026, the average hourly pay for medical review rn in Riverside, CA is $46.86, according to ZipRecruiter salary data. Most workers in this role earn between $35.87 and $55.67 per hour, depending on experience, location, and employer.

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
Utilization Review RN - Mid Shift (3pm - 11:30pm)

Utilization Review RN - Mid Shift (3pm - 11:30pm)

KPC GLOBAL MEDICAL CENTERS INC.

Santa Ana, CA • On-site

$50 - $85/hr

Other

Posted 10 days ago

Job description

SUMMARY

The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.

RESPONSIBILITIES AND DUTIES:

  • Coordinates and reviews all medical records, as assigned to caseload.
  • Actively participates in Case Management and Treatment Team meetings
  • Serves as on-going educator to all departments.
  • Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting
  • Able to work independently and use sound judgment.
  • Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
  • Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
  • Performs other duties as assigned.

This position is a mid-shift (3pm - 11:30pm) and will need to work on weekends.

EDUCATION & EXPERIENCE REQUIREMENTS:

  • Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
  • CA RN License Required
  • Minimum of 2 years' experience with the population of the facility and previous experience in utilization management preferred.

SKILLS & ABILITIES REQUIREMENTS:

  • Communication
  • Planning & Organizing
  • Problem Solving
  • Attention to Detail

PHYSICAL REQUIREMENTS:

  • Body Positions: Sitting and standing for prolonged periods.
  • Body Movements: Arm and hand dexterity.
  • Body Senses: Must have command of close and distant sight, color perception and hearing.
  • Strength: Ability to lift and move up to 25-pounds.

Working Environment:

  • Work in an office, where the climate is controlled.
  • OSHA exposure category: I
  1. Category I – Position includes tasks that involve exposure to Blood borne Pathogens.
  2. Category II – Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
  3. Category III – Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.
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About KPC Health

Sourced by ZipRecruiter

KPC Health has an integrated approach to serving the people of Riverside, San Bernardino and Orange County. Our acute care medical centers provide high quality, comprehensive and affordable healthcare for the entire family. For us, healthcare is not just about caring for our patients, but also about investing in the people throughout our communities. We are one team with one mission and that mission is for all our patients, and their families to Enjoy Life in Great Health.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Santa Ana, CA, US

Year founded

2004

Social media

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