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Medical Review Rn Jobs in Santa Rosa, CA (NOW HIRING)

GQR

RN - Case Manager

Santa Rosa, CA

$2.07K - $2.16K/wk

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

GQR Healthcare

Travel RN Case Manager

Santa Rosa, CA

$2.07K - $2.16K/wk

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

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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 Santa Rosa, CA is $49.10, according to ZipRecruiter salary data. Most workers in this role earn between $37.60 and $58.37 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
Travel Utilization Review RN - $1,737 per week

Travel Utilization Review RN - $1,737 per week

Focus

Santa Rosa, CA

$1.74K/wk

Other

Medical, Retirement

Posted 5 days ago

Job description

Focus Staff is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Santa Rosa, California.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: 06/15/2026
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel

We currently have a client in SANTA ROSA, CA looking for a Travel Utilization Review RN Registered Nurse!
Focus Staff is seeking a Travel Utilization Review RN Registered Nurse to review and audit behind the scenes to maximize the quality and cost efficiency of health care services.
Candidates need to possess phenomenal efficiency and attention to detail with a strong knowledge of procedures and patient safety. Being Compassionate and sensitive is a prerequisite for the profession. The ideal Candidates goes a step further by being a critical thinker and fast to act with emergencies.
If you are seeking a Utilization Review RN position and would like to work with an agency that will listen to your needs and career goals, then Focus Staff is the right place to be. We are proud of our ability to build relationships with all our healthcare professionals, whether you are seeking Travel assignments, PRN work or Permanent Placed positions.
Contract Assignment - 13 Weeks (Temporary)
Shift: 5x8 Days
Responsibilities:

  • Perform initial, concurrent, discharge, and retrospective reviews on all patients
  • Review current charts for appropriateness and correct admission status
  • Communicate directly with insurance companies and/or payor to obtain admission and continued stay certification or recertification
  • Facilitate peer to peer appeal for concurrent denials
  • Assign a working diagnosis related groups on all patients
  • Communicate with physicians regarding patients who do not meet criteria to identify additional documentation needs or potential status changes
  • Communicate effectively about problems or trends with insurance companies
  • Perform chart analysis on quality surveillance and special studies
  • All other responsibilities as needed
Requirements:
  • Motivated candidates who are looking for career growth
  • AHA Current Basic Life Support certification for Health Care Providers
  • Experience analyzing documentation of clinical care
  • Excellent communication skills with the staff, physicians, patients, and families

Work Experience: At least 2 years of experience
Rewards: (Utilization Review Registered Nurse Benefits)
  • Pay depends on location and experience.
  • We are offering a very competitive package to the right Utilization Review RN candidate.
  • Most traveling healthcare providers enjoy the flexibility and the capability to travel and work in various settings and work environments.
If You have a Passion for Utilization Review, Apply Today and a Recruiter will guide you through the Process.
Job Type: Contract/Temporary/Travel
Join our VIP team of Traveling Professionals!
Utilization RN – Utilization Review RN – Travel Utilization Review RN, Part-Time, Contract, Travel, Temporary, 13 Weeks, Temp. Tier5, Travel Utilization Review RN Registered Nurse

Focus Staff Job ID #a0xVt00000NdraHIAR. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel Utilization Review RN Registered Nurse

About Focus Staff

Your Journey, Our Focus. Travel Confidently, Care Boldly with Focus Staff.

At Focus Staff, we’re here to make your travel healthcare career rewarding, seamless, and stress-free.

Whether you’re a travel nurse, therapist, or allied health professional, we take care of the details so you can focus on what you do best — caring for others. Our mission is simple: to help healthcare heroes like you thrive, no matter where your journey takes you.

With thousands of job opportunities across all 50 states, our dedicated recruiters work closely with you to match you to the right assignment, based on what matters most to you — pay, location, benefits, or career growth.

From day one, you’ll enjoy premium benefits like medical coverage that bridges between assignments, 401K matching, travel and licensing reimbursements, and personalized housing support. Plus, our team is here for you 24/7, with clinical support available whenever you need guidance or backup.

At Focus Staff, we believe in making every assignment a smooth, comfortable, and empowering experience. Let’s make your next adventure your best one yet.

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