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Medical Review Rn Jobs (NOW HIRING)

CHI Health

Utilization Review RN

Omaha, NE · On-site

$33.51 - $48.58/hr

Job Summary and Responsibilities As our Utilization Review RN, you will play a pivotal role in optimizing healthcare delivery by ensuring medical necessity and appropriate patient status throughout ...

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $40.86/hr

Daily Responsibilities for Remote BH Utilization Review RN: * Evaluate a member's clinical condition through the review of medical records to determine the medical necessity for patient's behavioral ...

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How much do medical review rn jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for medical review rn in the United States is $44.91, according to ZipRecruiter salary data. Most workers in this role earn between $34.38 and $53.37 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.
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What states have the most Medical Review Rn jobs?

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Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, and 6% Contract. Highlights an 87% Physical, 1% Hybrid, and 12% Remote job distribution, with an average salary of $93,419 per year, or $44.9 per hour.

RN - Utilization Review

Well Sense Health Plan

Boston, MA • On-site

Other

Posted 5 days ago

Job description

Utilization Review Rn

Job Type: Travel

Profession: RN

Specialty: Utilization Review

Shift Details: Variable Shifts - 40 Hrs

Job Order Details: Start Date 09/01/2026 End Date 10/20/2026 Duration 7 Week(s)

Client Details: State MA

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