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Nurse Case Reviewer Jobs (NOW HIRING)

The Hartford

Nurse Case Manager

Hartford, CT · On-site +1

$69K - $104K/yr

Partner with supervisors and cross-functional teams to address barriers, resolve issues, and support overall claim performance through meetings and case reviews Required Qualifications * RN with ...

KSA Integration

RN Case Manager

Colchester, VT · On-site

The RN Case Manager works under the direction of the Lead RN Case Manager in support of the VTARNG ... Prepare Soldier records for and attend MEB/PEB boards; review and reconcile hardcopy and electronic ...

KSA Integration

RN Case Manager

Colchester, VT · On-site

The RN Case Manager works under the direction of the Lead RN Case Manager in support of the VTARNG ... Prepare Soldier records for and attend MEB/PEB boards; review and reconcile hardcopy and electronic ...

NCH

RN Case Manager Lead

Naples, FL · On-site

The RN Case Manager Lead will act as a resource for the RN Case Managers while ensuring the ... complex case review. • Promotes and fosters a collaborative, supportive and efficient team ...

KSA Integration

RN Case Manager

Colchester, VT · On-site

The RN Case Manager works under the direction of the Lead RN Case Manager in support of the VTARNG ... Prepare Soldier records for and attend MEB/PEB boards; review and reconcile hardcopy and electronic ...

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How much do nurse case reviewer jobs pay per hour?

As of Jul 6, 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
Remote Medical Case Reviewer - Injury & Vaccine Compensation Programs (Contract)

Remote Medical Case Reviewer - Injury & Vaccine Compensation Programs (Contract)

PsyPhyCare

Remote

$70/hr

Part-time

Posted 29 days ago

Job description

Remote Medical Case Reviewer (Contract)
Location: Remote
About the Opportunity
PsyPhyCare is seeking Medical Case Reviewers to support a federal healthcare program focused on evaluating vaccine- and countermeasure-related injury claims. These programs provide compensation for individuals who may have suffered vaccine- or countermeasure-related injuries.
As a Medical Case Reviewer, you will analyze petitions, medical records, and expert testimony to provide impartial, evidence-based recommendations. This is a remote, contract-based opportunity with highly competitive hourly compensation.
Responsibilities
  • Review medical case files including petitions, medical records, affidavits, depositions, and supporting documentation.
  • Assess adequacy of information and evaluate likelihood of causation using medical principles and literature.
  • Prepare written reports and recommendations for legal and administrative teams.
  • Consult with medical experts, team leads, and attorneys as needed.
  • Participate in case presentations and consensus discussions.
  • Ensure compliance with records management, HIPAA, and confidentiality standards.
  • If required, provide testimony in legal proceedings (travel reimbursed under federal travel guidelines).

Qualifications
For MD/DO Medical Case Reviewers:
  • Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited institution.
  • Active, full, and unrestricted U.S. medical license.
  • At least 5 years of experience in clinical practice or case review.
  • Strong writing and analytical skills.

For PhD/Advanced Degree Reviewers:
  • Doctor of Philosophy (PhD) in a relevant biomedical or clinical discipline OR advanced degree (e.g., NP, PA, RN).
  • At least 3 years of experience conducting medical case reviews/evaluations.
  • Proficiency in medical research, literature analysis, and report writing.

Preferred Specialties: Pediatrics, Immunology, Neurology, Infectious Disease, Internal Medicine, Epidemiology, Rheumatology, and related fields.

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