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Nurse Case Reviewer Jobs (NOW HIRING)

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 ...

Carilion Clinic

RN Case Manager

Roanoke, VA

R151592 RN Case Manager (Open) How You'll Help Transform Healthcare: Full time : Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carillion Clinic

RN Case Manager

Roanoke, VA · On-site

RN Case Manager (Open) Full time : Monday - Friday, 8am-4:30pm Sign on bonus and relocation ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager

Roanoke, VA

R151592 RN Case Manager (Open) How You'll Help Transform Healthcare: Full time : Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager

Roanoke, VA

R160315 RN Case Manager - Weekends - Full time (Open) How You'll Help Transform Healthcare: **Sign ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager

Roanoke, VA

R161382 RN Case Manager - Weekends (Open) How You'll Help Transform Healthcare: Full time and ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

R151592 RN Case Manager (Open) How You'll Help Transform Healthcare: Full time : Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

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Nurse Case Reviewer information

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$47

$80

How much do nurse case reviewer jobs pay per hour?

As of Aug 23, 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 is a nurse case reviewer?

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.

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

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 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 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.

How to become a nurse case reviewer?

To become a nurse case reviewer, you typically need a registered nurse (RN) license and several years of clinical experience. Additional qualifications may include knowledge of insurance processes, medical record review, and familiarity with healthcare regulations; some roles also require certification in case management or utilization review.
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Nurse Case Reviewer jobs near you
Infographic showing various Nurse Case Reviewer job openings in the United States as of August 2026, with employment types broken down into 3% As Needed, 83% Full Time, 7% Part Time, and 7% Contract. Highlights an 83% In-person, and 17% Remote job distribution, with an average salary of $98,869 per year, or $47.5 per hour.

Medical Record Reviewer

Community Home Health Care & CIHC

Fort Wayne, IN

Full-time

Re-posted 10 days ago

Job description

Medical Record Reviewer Community Home Health Care is hiring an in-office QA Nurse to oversee the accuracy, completeness, and regulatory compliance of all clinical documentation. This role is essential to ensuring our client records meet professional standards and support safe, high-quality care. What You'll Do Clinical Record Audits & Documentation Review
  • Perform monthly audits of skilled nursing notes for all visiting nurses.
  • Provide direct, timely feedback to nurses on missing or incorrect documentation.
  • Re-audit records when deficiencies continue and notify the Clinical Manager as needed.
  • Audit OASIS assessments (SOC, ROC, Recertification, and Follow-Up) prior to transmission.
  • Audit at least 10% of each RN Case Manager's charts monthly, focusing on recerts, SOC, and ROC visits.
  • Audit all documentation for newly hired RN Case Managers during their probation period.
  • Complete discharge record reviews and notify RN Case Managers when discharge charts need QA review.
Deficiency Identification & Follow-Up
  • Review charts for accuracy, completion, legal compliance, and proper care documentation.
  • Document deficiencies on the Case Conference Review form.
  • Notify nurses and department staff of deficiencies and required corrections.
  • Conduct discharge analysis when clients leave the agency.
Reporting & Collaboration
  • Track patterns and trends in documentation issues.
  • Communicate concerns and recurring problems to the Clinical Manager.
  • Support corrective action steps when needed.
  • Compile a quarterly audit report summarizing the previous three months.
  • Assist with ongoing chart review processes as assigned.
What We're Looking For
  • Active RN license in the State of Indiana.
  • Strong understanding of home health documentation standards, Medicare/Medicaid requirements, and OASIS.
  • Excellent attention to detail and strong organizational skills.
  • Ability to communicate clearly, professionally, and constructively with nursing staff.
  • Comfortable working fully in-office in a fast-paced environment.
  • Previous QA or chart auditing experience preferred, but strong clinical documentation skills will also be considered.
Schedule & Work Environment
  • Monday-Friday schedule, in-office at the Fort Wayne location.
  • Works closely with the Clinical Manager, RN Case Managers, and field staff.
  • Computer-based role with consistent chart auditing and record review responsibilities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local laws. We are committed to creating a diverse and inclusive workplace for all employees.

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