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Medical Review Rn information

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$25

$46

$73

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
Registered Nurse, Med Surg Full-time Days

Registered Nurse, Med Surg Full-time Days

KPC GLOBAL MEDICAL CENTERS INC.

Hemet, CA • On-site

$45.34 - $62.48/hr

Other

Posted 14 days ago

Job description

Position Summary:

We are seeking compassionate and skilled Registered Nurses (RNs) to join our patient-centered team. Under supervision, the RN provides direct and indirect patient care services in an acute care and/or non-acute care setting. The ideal candidate will support physicians, coordinate care plans, and ensure safe and high-quality outcomes for patients and their families. RNs are also expected to contribute to quality assurance activities, policy review, and ongoing professional development initiatives.

Key Responsibilities:

  • Deliver patient care based on established hospital policies and evidence-based practices.
  • Monitor patient progress and document findings accurately in electronic medical records.
  • Collaborate with interdisciplinary teams to implement individualized patient care plans.
  • Administer medications and treatments per provider orders and monitor patient responses.
  • Respond to emergencies using appropriate nursing interventions and critical judgment.
  • Adhere to safety, infection control, and regulatory standards.
  • Participate in continuous quality improvement, in-service education, and staff training.
  • Float or be assigned to units based on patient care needs and organizational priorities.

Qualifications:

Education:

  • Associate Degree in Nursing (ADN) or completion of an accredited Registered Nurse program required.
  • Bachelor of Science in Nursing (BSN) preferred.

Experience:

  • Non-Specialty Units: No minimum experience required – new graduate RNs welcome.
  • Specialty Units (ICU, ER, OR, L&D, etc.): Minimum of one (1) year of acute care RN experience.

Licensure & Certifications:

  • Current and valid Registered Nurse (RN) license issued by the State of California – Required
  • BLS (Basic Life Support) – Required
  • ACLS, PALS, NRP, Basic Arrhythmia, and/or Fetal Heart Monitoring – May be required based on unit assignment

Knowledge, Skills & Abilities:

  • Knowledge of the Nursing Practice Act and applicable federal, state, and local regulations.
  • Familiarity with hospital safety, infection control, and quality assurance practices.
  • Ability to manage emergency situations and make sound clinical decisions under pressure.
  • Skilled in maintaining accurate records and communication with interdisciplinary teams.
  • Strong interpersonal skills to establish trust and rapport with patients, families, and coworkers.
  • Ability to adapt quickly in a fast-paced environment with changing priorities.

Physical Requirements:

  • Prolonged periods of walking, standing, and sitting.
  • Must be able to lift and position patients and equipment (up to 50 lbs).
  • Manual dexterity and sensory acuity required to perform essential functions.
  • Ability to respond quickly in emergency situations.

Age-Specific Competency:

Must demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served, including physical, psychosocial, and cultural needs.

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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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