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

Uniti Med

Travel Nurse RN - Med Surg

Saint Helena, CA

$2.46K - $3.30K/wk

Uniti Med is seeking a travel nurse RN Med Surg for a travel nursing job in St. Helena, California. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 40 ...

Uniti Med

Travel Nurse RN - Med Surg

Saint Helena, CA

$2.46K - $3.30K/wk

Uniti Med is seeking a travel nurse RN Med Surg for a travel nursing job in St. Helena, California. & Requirements * Specialty: Med Surg * Discipline: RN * Start Date: 06/22/2026 * Duration: 13 weeks ...

Suncrest Hospice

Registered Nurse (RN)

Santa Rosa, CA · On-site

$55 - $65/hr

Benefits Package including Medical, Dental, and Vision insurance * Paid Time Off * 401k plan with ... The Registered Nurse (RN) will work in either a Case Management, Admissions, or Resource role.

Suncrest Hospice

Registered Nurse (RN)

Novato, CA

$55 - $65/hr

Benefits Package including Medical, Dental, and Vision insurance * Paid Time Off * 401k plan with ... The Registered Nurse (RN) will work as a Resource. Qualifications * Current Registered Nurse (RN) ...

Suncrest Hospice

Registered Nurse (RN)

Novato, CA · On-site

$55 - $65/hr

Benefits Package including Medical, Dental, and Vision insurance * Paid Time Off * 401k plan with ... The Registered Nurse (RN) will work as a Resource. Qualifications * Current Registered Nurse (RN) ...

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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.
What are popular job titles related to Medical Review Rn jobs in Santa Rosa, CA? For Medical Review Rn jobs in Santa Rosa, CA, the most frequently searched job titles are:
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Medical Review Rn jobs near you

Registered Nurse - Utilization Review - RNUR26-06086

NavitasPartners

Novato, CA • Remote

$40/hr

Other

Posted 7 days ago

Job description

Job Title: Registered Nurse - Utilization Review 

Location: Santa Rosa, CA 

Shift Details: Day Shift | 5x8 Hours | 08:00 AM - 04:30 PM
Contract Duration: 13 Weeks
Orientation: 40 Hours (Non-Billable)

Required Qualifications
  • Active Registered Nurse (RN) License required
  • Minimum 1-2 years acute care experience preferred
  • Experience in Utilization Review, Case Management, or similar clinical coordination role preferred
  • Strong understanding of medical necessity criteria and payer guidelines
  • Knowledge of insurance authorization and review processes
  • Strong documentation, analytical, and communication skills
  • Ability to work independently in a remote setting
  • Experience with EMR systems preferred (Epic preferred)
Job Responsibilities
  • Perform utilization review for inpatient and outpatient services
  • Evaluate medical records for appropriate level of care and medical necessity
  • Process prior authorizations and continued stay reviews
  • Collaborate with physicians, case managers, and insurance payers
  • Document review decisions accurately in EMR systems
  • Identify cases requiring escalation to clinical reviewers or medical directors
  • Support discharge planning and care coordination when needed
  • Ensure compliance with regulatory, payer, and facility guidelines
  • Maintain productivity and quality standards in a remote environment

For more details contact at sthakur@navitashealth.com 

About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

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