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Nurse Case Reviewer Jobs (NOW HIRING)

Elevance Health

Case Reviewer - NP/PA

Miami, FL · On-site

Case Reviewer - NP/PA Case Reviewer - NP/PA Location: Miami, FL Virtual : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum ...

Elevance Health

Case Reviewer - NP/PA

Miami, FL · On-site

Case Reviewer - NP/PA Location: Miami, FL Virtual : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...

LAUKOA

Registered Nurse Case Manager

Tampa, FL

$82K - $97K/yr

As a RN Case Manager (also known as a Permanent Case Reviewer) [PCR], you will provide the services of Medical Case Management in support of Individual Medical Readiness to the Army Reserve Medical ...

LAUKOA

Registered Nurse Case Manager

Pinellas Park, FL

$82K - $97K/yr

As a RN Case Manager (also known as a Permanent Case Reviewer) [PCR], you will provide the services of Medical Case Management in support of Individual Medical Readiness to the Army Reserve Medical ...

DAWSON

Registered Nurse Case Manager

Tampa, FL

$82K - $97K/yr

As a RN Case Manager (also known as a Permanent Case Reviewer) [PCR], you will provide the services of Medical Case Management in support of Individual Medical Readiness to the Army Reserve Medical ...

DAWSON

Registered Nurse Case Manager

Pinellas Park, FL · On-site

$82K - $97K/yr

As a RN Case Manager (also known as a Permanent Case Reviewer) [PCR], you will provide the services of Medical Case Management in support of Individual Medical Readiness to the Army Reserve Medical ...

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Nurse Case Reviewer information

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$19

$47

$80

How much do nurse case reviewer jobs pay per hour?

As of Jul 26, 2026, the average hourly pay for nurse case reviewer in the United States is $47.53, according to ZipRecruiter salary data. Most workers in this role earn between $35.34 and $57.45 per hour, depending on experience, location, and employer.

What are some common challenges Nurse Case Reviewers face when balancing clinical assessments with administrative responsibilities?

Nurse Case Reviewers often encounter the challenge of managing a high volume of cases while ensuring each review is thorough and compliant with regulations. Balancing direct clinical assessment with detailed documentation and administrative tasks requires strong organizational skills and the ability to prioritize effectively. Additionally, they must frequently collaborate with healthcare providers, insurance representatives, and patients, which can involve navigating differing perspectives and complex cases. Effective communication and time management are key to overcoming these challenges and maintaining quality in decision-making.

What are the key skills and qualifications needed to thrive as a Nurse Case Reviewer, and why are they important?

To thrive as a Nurse Case Reviewer, you need a strong clinical background, active RN licensure, and experience in case management or utilization review. Familiarity with electronic medical records (EMR) systems, InterQual or Milliman guidelines, and relevant certifications such as CCM (Certified Case Manager) are highly valued. Excellent analytical thinking, attention to detail, and effective communication are crucial soft skills for evaluating cases and collaborating with healthcare teams. These skills are essential for ensuring accurate, evidence-based reviews that support quality care while managing costs and compliance.

What is the difference between Nurse Case Reviewer vs Nurse Auditor?

AspectNurse Case ReviewerNurse Auditor
CredentialsRN license, case review experienceRN license, auditing certifications (if any)
Work EnvironmentInsurance companies, healthcare organizationsInsurance companies, third-party auditing firms
Job FocusReview patient cases for appropriateness and coverageAudit claims and documentation for compliance and accuracy

Both Nurse Case Reviewers and Nurse Auditors are vital in healthcare claims management. While Nurse Case Reviewers focus on evaluating patient cases for coverage and medical necessity, Nurse Auditors primarily verify the accuracy and compliance of claims. Both roles require nursing credentials and are commonly employed in insurance and healthcare settings, but their specific responsibilities differ slightly.

What are Nurse Case Reviewers?

Nurse Case Reviewers are registered nurses who evaluate medical records, treatment plans, and patient cases to ensure the care provided meets established standards and guidelines. They typically work for insurance companies, healthcare organizations, or third-party review agencies to assess the necessity, appropriateness, and quality of medical care. Their role can involve reviewing claims, providing recommendations for coverage or further treatment, and ensuring compliance with regulations. Nurse Case Reviewers play a critical part in helping control healthcare costs while maintaining patient safety and quality of care.
More about Nurse Case Reviewer jobs
What states have the most Nurse Case Reviewer jobs? States with the most job openings for Nurse Case Reviewer jobs include:
What job categories do people searching Nurse Case Reviewer jobs look for? The top searched job categories for Nurse Case Reviewer jobs are:
Nurse Case Reviewer jobs near you
Infographic showing various Nurse Case Reviewer job openings in the United States as of July 2026, with employment types broken down into 87% Full Time, and 13% Contract. Highlights an 81% In-person, and 19% Remote job distribution, with an average salary of $98,869 per year, or $47.5 per hour.
Case Reviewer

Case Reviewer

Absolute Staffing & Consulting Solutions

Columbia, MD • Hybrid

$23 - $27/hr

Full-time

Posted 3 days ago

Job description

Absolute Staffing & Consulting Solutions is looking for a Case Reviewer to join our team of professionals. This is a hybrid role in Maryland. If the description below sounds like you, Apply Now!


Position Summary


As a Case Reviewer, you will be responsible for performing utilization reviews to authorize services for individuals enrolled in Medicaid. The utilization review process involves applying program policies, verifying medical, technical, and financial eligibility, and reviewing medical records to issue decisions regarding pre-authorization of services. 

 

Essential Functions

  • Provides review decisions for prospective reviews based on an established set of criteria.
  • Screens situations according to specific criteria to determine if care is appropriate.
  • Refers cases that fail to meet criteria to a Registered Nurse or Social Worker reviewer.
  • Ensures review is conducted thoroughly and within specified timeframes.
  • Serves as liaison among clinical reviewer, provider, facility, and/or subscriber.
  • Documents medical information supporting decisions into the workflow documentation system, ensuring data is entered accurately and timely.
  • Ensures quality customer service by responding to email and phone inquiries from providers and consumers.


Requirements

  • Bachelor’s degree in the health or human services and at least 1 year of experience in utilization review or 1 year of experience evaluating, analyzing, researching and developing health care services, policies and programs preferred OR
  • A high school diploma or equivalent may substitute for a bachelor’s degree with at least 3 years of experience in utilization review or 3 years of experience evaluating, analyzing, researching and developing health care services, policies and programs.
  • Demonstrated ability working with confidential information and in a deadline-driven environment.
  • Excellent verbal and written communication skills
  • Comfortable with completing basic math functions.
  • Attention to detail, analytical skills, and the ability to interpret medical documentation accurately.
  • Possess intermediate PC skills including navigating electronic health records and other computer software.
  • Ability to work independently and as part of a team.
  • Organizational skills and time management.
  • Experience in a community health care environment preferred.
  • Experience with utilization review of medical services preferred.
  • Satisfactory completion of medical terminology course preferred.
  • Preferably reside in the state of Maryland

Preferred Skills and Certifications

  • Proficiency with Sharepoint
  • Possess intermediate skills in Excel
  • Strong analytical and critical thinking skills
  • Previous support planner experience a plus


Shift:

 Monday - Friday from 8 am-5 pm EST


Base Pay:

$23- $27/ hour


Why work for our client?

Our client is one of the country's most respected population health management organizations. They work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.

Health has changed a lot through our 50-year history, but what has remained constant is that they care deeply about who they serve and what they do. Their success is built on their ability to adapt, respond to client needs, and offer innovative solutions at every turn.

Our client is looking for talented individuals who not only believe in the mission, but who are ready to take ownership and make a difference in the lives of people, in the world of health.