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Medical Review Rn Jobs (NOW HIRING)

Empower AI Inc.

Medicare Part A RN clinical review * Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Outpatient Facilities and ...

Trinityhealth

Utilization Review RN

Des Moines, IA

MercyOne Des Moines Medical Center, founded by the Sisters of Mercy in 1893, is the longest ... Current licensure as a registered nurse in the State of Iowa. * Five (5) years clinical nursing ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

Perform automated and complex medical record and claim reviews to make coverage determinations ... Registered Nurse, with a current unobstructed license to practice nursing in the United States.

Mercy Medical Center

Medical Review Coordinator

Aurora, IL · On-site

$32 - $46.35/hr

Mercy Medical Center Location : Aurora, IL Responsibilities Coordinates and reviews all medical ... Nursing Graduate required. Preferred qualifications: 1. ECFMG Certification And/or Bachelor's or ...

CareConnect

Utilization Review RN

Greenvale, NY · On-site

Performs medical necessity reviews for selected procedures and services. * Provides timely and ... Bachelor's Degree in Nursing, preferred. Must be enrolled in an accredited program within 24 months ...

Empower AI Inc.

Medical Reviewer III (Medicare/DME)

Completes other projects or duties as assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

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How much do medical review rn jobs pay per hour?

As of Jul 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.

Can I make $500,000 as a nurse?

Medical Review RNs typically do not earn $500,000 annually, as most nursing salaries are below that level. High earnings in nursing usually require advanced roles, specialized certifications, management positions, or work in high-paying industries or locations. Achieving such a salary may involve additional education, experience, and responsibilities beyond standard nursing roles.

What does a medical review RN do?

A Medical Review RN evaluates insurance claims, medical records, and provider documentation to determine coverage and compliance with policies. They ensure accurate assessment of medical necessity, often working with healthcare providers and insurance companies, and may require knowledge of medical coding and documentation standards.

How to make $300,000 as a nurse?

Medical Review RNs can increase their earnings by gaining specialized certifications, such as in case management or legal nurse consulting, and working in high-demand settings like telehealth or insurance companies. Advancing to senior or managerial roles, working overtime, or taking on consulting projects can also boost income toward $300,000 annually.

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.

How to make an extra 2000 a month as a nurse?

Medical Review RNs can increase their income by taking on additional freelance or per diem review assignments, working overtime, or obtaining specialized certifications to qualify for higher-paying roles. Developing expertise in specific medical areas or coding can also lead to higher-paying opportunities outside regular hours.

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.
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Medical Review Rn jobs near you
Infographic showing various Medical Review Rn job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $93,419 per year, or $44.9 per hour.
Registered Nurse - Medical Review Specialist

Registered Nurse - Medical Review Specialist

Avosys Technology, Inc.

Remote

Full-time

Posted 3 days ago

Job description

ABOUT AVOSYS
Avosys is a growing integrator of professional, technological and management solutions services. Founded in 1998, Avosys provides services nationwide to Federal, Commercial, Local and State clients. We recognize the foundation of our firm is our people and we continue to rise above our competition by hiring the best.
DESCRIPTION
Is it your calling to serve our Nation's Heroes? Avosys is seeking a Registered Nurse - Medical Review Specialist to provide services to the military and their families.
EMPLOYMENT WITH AVOSYS
  • Maximize family time with no weekend, Holiday, or on-call requirements
  • Maintain work-life balance with guaranteed 8-hour shifts
  • Achieve peace of mind with malpractice insurance provided at no cost

TITLE: Registered Nurse - Medical Review Specialist
LOCATION: Remote work from home.
HOURS: Monday thru Friday 8 hour shift with core hours between 8-2 CST 9-3 EST, no overtime is allowed.
SUMMARY:
Perform clinical reviews of Medicare Part A and Part B claims for Medical Review, Redeterminations/Appeals (Appeals), and Prior Authorization requests (collectively, the "Services") in accordance with CMS (Centers for Medicare & Medicaid Services) requirements.
QUALIFICATIONS:
  • Minimum of two (2) years' clinical experience
  • Active and current Registered Nurse license
  • Bachelor's required
  • Excellent written and oral communication skills
  • Demonstrated experience with evaluating medical and health care delivery issues
  • Strong computer skills to include Microsoft Office proficiency
  • Preferred (but not required) qualifications:
  • Insurance industry experience
  • Oral and written English-Spanish bilingual skills

RESPONSIBILITIES: include, but not limited to:
  1. Clinical review of services:
    • Review medical record documentation within CMS timeliness parameters (i.e., 20 days from receipt of the medical record for pre-payment reviews and 50 days from receipt of the medical record for post payment reviews).
    • Utilize the applicable Medicare policies (i.e., Local Coverage Determinations, National Coverage Determinations, Internet-Only Manual (IOM) citations, inpatient tools, etc.) to ensure the services comply with all Medicare regulations and documentation requirements.
    • Review documentation for medical necessity per guidelines outlined in the Social Security Act 1862(a)(1).
    • Ensure that all documentation includes a valid signature consistent with the signature requirements.
  2. Documentation of rationale for processing decisions:
    • Provide a claim sample of three (3) claims to Companies via established protocols and timeliness parameters (i.e., 18 days from receipt of the medical record for pre-payment reviews and 48 days from receipt of the medical record for post payment reviews) for quality review prior to finalization of documentation of reason for payment, reduction, or denial of service to ensure accuracy of claim decision making.
    • Companies will review the three-claim sample for accuracy of claim decision and will make and return decisions to the MRS within 24 hours or less.
    • Complete the documentation of the reason for payment, reduction, or denial of service for all claims on an electronic decision template to be provided by Companies. This rationale must be in sentence format so that it may be inserted directly into the response to the provider, must be clear and well-written, and contain sufficient information to educate the providers on how the review decision was made.
    • Return documented decision electronically to Companies via established protocols and timeliness parameters (i.e., 20 days from receipt of the medical record for pre-payment reviews and 50 days from receipt of the medical record for payment reviews).
    • Complete the review results letter in the Companies' letter writing system within 35 days from receipt of the medical record for pre-payment reviews and no later than 60 days from receipt of the medical record for post payment reviews.
    • Document all case activity in Companies' provider tracking system on the day the activity occurs.
    • Complete one-on-one provider education (i.e., webinar, conference call, etc.) within 30 days of sending out review results letter.
    • Respond to provider inquiries related to case and/or claims throughout the course (i.e. in 24 hours or less) of review.
    • If additional clinical guidance is required, complete the Contractor Medical Director ("CMD") assistance form, track response, and update review accordingly.
    • Conduct telephone development for missing or additional records for easily curable errors.
    • Notate date of receipt of additional documentation received in the Companies' provider tracking system.
    • Upon request by Companies, initiate or participate in provider teaching activities, creating written teaching material, providing one-on-one education or education to a group as a result of an MR review.
    • If fraud activity is suspected, immediately complete initial referral packet for external entity referral and return the packet to the Companies.
    • Complete referrals to Companies' provider outreach and education ("POE") area in provider tracking system for cases that have a moderate or major error rate.
    • Lead and Alternate Lead will participate in all monthly departmental training and meetings, and all Staff will participate as requested.
    • Submit all cases for review and approval for quality and closure of cases.

Job responsibilities are subject to change to meet Military Treatment Facility requirements. Additional immunization record, security and background check requirements are also considered as qualifying criteria.
Position Type: Full Time
Location: Remote
Industry: Government Contracting
Shift: Day Business Hours
Travel: No
Salary: Based on Experience
Telework: Yes
Equal Opportunity Employer/Veterans/Disabled
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact (210) 888-0775 or Jobs@Avosys.com for assistance.

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