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Medical Review Jobs (NOW HIRING)

Molina Healthcare

Medical Review Nurse (RN)

Long Beach, CA · Remote

$29.05 - $56.64/hr

Job Duties Facilitates medical review of prospective, retrospective, and concurrent review of appeals for denied prior authorizations. Includes standard and expedited cases, inpatient, outpatient ...

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Medical Review information

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$36.5K

$164.7K

$337K

How much do medical review jobs pay per year?

As of Aug 17, 2026, the average yearly pay for medical review in the United States is $164,731.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,000.00 and $268,500.00 per year, depending on experience, location, and employer.

What is medical review?

Medical review refers to the process of evaluating medical information, records, or claims to ensure accuracy, compliance, and appropriateness based on clinical guidelines and policies. Professionals in medical review often assess documentation for insurance claims, pre-authorization requests, or clinical trials. Their work helps ensure that patients receive appropriate care and that healthcare providers follow industry standards.

What are the key skills and qualifications needed to thrive as a medical reviewer?

To thrive as a Medical Reviewer, you need a strong understanding of clinical medicine, scientific research, and regulatory guidelines, often supported by a medical degree or advanced healthcare qualification. Familiarity with medical databases, regulatory submission systems, and tools like MedDRA coding or CTD formatting is typically required. Attention to detail, analytical thinking, and effective written communication are essential soft skills for reviewing complex documents and collaborating with multidisciplinary teams. These skills ensure accurate, compliant, and high-quality medical evaluations that support regulatory approvals and patient safety.

How does a medical review professional typically collaborate with other departments within a healthcare or insurance organization?

Medical Review professionals frequently work closely with clinical staff, claims adjusters, and compliance teams to ensure that medical records and claims are accurately assessed and meet regulatory standards. Collaboration often involves discussing complex cases, clarifying clinical documentation, and providing guidance on policy interpretation. Effective communication and teamwork are essential, as Medical Review staff often act as a bridge between medical and administrative teams to support fair and thorough claims processing.

What is the difference between Medical Review vs Medical Coding Specialist?

AspectMedical ReviewMedical Coding Specialist
Required CredentialsMedical degree or clinical background, certifications like CCM or CRCCertification in coding (CPC, CCS), knowledge of coding systems
Work EnvironmentHealthcare facilities, insurance companies, telehealthHospitals, clinics, insurance companies, remote coding
Employer & Industry UsageUsed to assess medical necessity, compliance, and documentationUsed to assign billing codes based on medical records

Medical Review involves evaluating medical records for accuracy, compliance, and appropriateness, often requiring clinical expertise. Medical Coding Specialists focus on translating medical documentation into standardized codes for billing and insurance purposes. While both roles require healthcare knowledge, Medical Review emphasizes clinical assessment, whereas Medical Coding centers on coding accuracy for reimbursement.

How do you become a medical reviewer?

To become a medical reviewer, typically one needs a medical degree such as an MD or DO, along with clinical experience in a relevant specialty. Additional qualifications may include familiarity with medical guidelines, strong analytical skills, and sometimes certification in medical review or coding; some roles also require knowledge of healthcare regulations and documentation standards.

How much do medical reviewers make in the US?

Medical reviewers in the US typically earn between $60,000 and $90,000 annually, depending on experience, location, and employer. Many roles require medical credentials and familiarity with healthcare regulations, with some positions offering additional benefits or bonuses.
More about Medical Review jobs

What cities are hiring for Medical Review jobs?

Cities with the most Medical Review job openings:

What are the most commonly searched types of Medical Review jobs?

The most popular types of Medical Review jobs are:

What states have the most Medical Review jobs?

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

What job categories do people searching Medical Review jobs look for?

The top searched job categories for Medical Review jobs are:

Medical Review jobs near you
Infographic showing various Medical Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $164,731 per year, or $79.2 per hour.

Registered Nurse - Medical Review Specialist

Hospitality Spotlight

Springfield, VA • On-site

$45 - $50/hr

Full-time

Re-posted 9 days ago

Job description


Registered Nurse - Medical Review Specialist
A Hospitality Spotlight client supporting a federal agency is seeking a Registered Nurse to assist with medical case reviews and occupational health assessments. This role plays an important part in reviewing employee medical information and supporting workforce readiness determinations.
The position is based in Springfield, Virginia, with opportunities for a hybrid work arrangement after required training and clearance processes are completed.
The Work
  • Review employee-submitted electronic medical questionnaires and supporting documentation
  • Evaluate medical histories and health records using established medical guidelines and review protocols
  • Identify cases requiring additional medical information or clarification
  • Communicate with employees regarding medical documentation and follow-up requirements
  • Review records received from healthcare providers and determine next steps based on established criteria
  • Document findings, recommendations, and case activity within electronic record systems
  • Support fitness-for-duty evaluations and leave-related medical reviews as needed
  • Assist with medical documentation related to employee accommodation requests and administrative cases
  • Maintain confidentiality while handling protected health information and sensitive records
  • Provide exceptional service and communication throughout the review process
  • Contribute ideas that improve workflow efficiency and case review processes
  • Perform additional duties as assigned

What You've Done
  • Hold an active, unrestricted Registered Nurse license in Virginia
  • Bachelor of Science in Nursing (BSN) required. Master's degree preferred
  • Minimum of 3 years of occupational health, employee health, case management, or related nursing experience preferred
  • U.S. Citizenship required
  • Experience reviewing medical documentation and applying clinical judgment to case evaluations
  • Strong understanding of medical terminology, treatment plans, and common health conditions
  • Experience maintaining confidential medical information and regulatory compliance standards
  • Ability to obtain and maintain required federal background investigation and security clearance requirements

What Sets You Apart
  • Strong analytical and critical-thinking skills
  • Exceptional attention to detail and documentation accuracy
  • Ability to interpret medical information and apply established review guidelines
  • Excellent verbal and written communication skills
  • Comfortable working independently while managing a high-volume workload
  • Strong organizational and case management abilities
  • Experience utilizing electronic medical record systems and case management platforms
  • Ability to prioritize tasks and meet established timelines
  • Proficiency with Microsoft Office and computer-based systems
  • Physical Requirements
  • Position requires periods of standing and walking throughout the workday.

Location
  • Springfield, VA
  • Hybrid work opportunity available following successful completion of onboarding, background investigation, and security requirements.

Compensation
  • Hourly rate of $45.00 - $50.00

If you're looking for a meaningful nursing opportunity that combines clinical knowledge, case review, and federal program support, we'd love to connect.
Submit your resume to learn more.
We look forward to connecting and shining our spotlight on you.
- Hospitality Spotlight Team

Apply