ZipRecruiter

Log In

1

Medical Review Rn Jobs (NOW HIRING)

Saratoga Ascend

Medical Review Manager

Catonsville, MD · On-site

Medical Review Manager Saratoga Medical has an immediate opening for a Medical Review Manager for a ... S. and a currently licensed RN * Minimum of five years of experience practicing as an RN in either ...

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 ...

New

Louisiana Workforce Commission

Utilization Review RN

Knowledge of standardized code sets and medical terminology is required * Knowledge of provider and ... Current, unrestricted Nursing\RN - Registered Nurse - State Licensure And/Or current, unrestricted ...

Medica

Utilization Review RN III

$70K - $120K/yr

Utilization review activities require interfacing with members, providers, clinics, medical ... Active, unrestricted RN license required This position is a Remote role. To be eligible for ...

Mission Hospital

RN - Utilization Review

Tuba City, AZ · On-site

$2.6K/wk

RN,AZ - Utilization Review RN, City: Tuba City, State: Arizona, Estimated Start Date:09/07/2026 ... The Convergence Medical Staffing Mobile App enables our travelers to search for jobs as well as ...

previous pagenext page

Showing results 21-40

All JobsHealthcare JobsNursing JobsNurse Case Manager JobsMedical Review Rn Jobs

Medical Review Rn information

See salary details

$24

$44

$70

How much do medical review rn jobs pay per hour?

As of Aug 29, 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.
More about Medical Review Rn jobs

What cities are hiring for Medical Review Rn jobs?

Cities with the most Medical Review Rn job openings:

What states have the most Medical Review Rn jobs?

States with the most job openings for Medical Review Rn jobs include:

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.

Medical Review Manager

Catonsville, MD • On-site

Saratoga Ascend
See more jobs at Saratoga Ascendexternal

Other

Re-posted 11 days ago

Job description

Medical Review Manager

Saratoga Medical has an immediate opening for a Medical Review Manager for a program supporting the Centers for Medicare and Medicaid Services (CMS) in Catonsville, MD. The work hours are Monday to Friday from 8:30 am to 5:00 pm.

Qualifications:

  • Board certified in nursing and licensed to practice nursing in the U.S. and a currently licensed RN
  • Minimum of five years of experience practicing as an RN in either an acute hospital, skilled nursing facility, or an office/clinic-based medical practice
  • Minimum of two years of experience of supervisory experience with Medicare's program coverage and payment rules
  • Experience in MR processes of Medicare Administrative Contractors (MACs), CERT, Supplemental Medical Review Contractor (SMRC), or Railroad Retirement Board (RRB) MAC is preferred

Responsibilities:

  • Supervise the Nurse Review staff
  • Development, oversight, and implementation of the CERT accuracy medical review processes while supervising the medical review nurses
  • Collaborate with the Program Manager, CMD, and other contract staff

Saratoga Medical Center, Inc. is an equal opportunity employer and will not discriminate in recruiting, hiring, training, promotion, transfer, discharge, compensation or any other term or condition of employment on the basis of race, religion, color, age (over age 39), sex, national origin, or on the basis of disability if the employee can perform the essential functions of the job, with a reasonable accommodation if necessary.

Apply