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Nurse Reviewer Jobs (NOW HIRING)

Elevance Health

Nurse Reviewer 1

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Elevance Health

Nurse Reviewer 1

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Elevance Health

Nurse Reviewer 1

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Elevance Health

Nurse Reviewer 1

Atlanta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Elevance Health

Nurse Reviewer 1

Mason, OH · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Elevance Health

Nurse Reviewer 1

Wilmington, DE · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Elevance Health

Nurse Reviewer 1

Mason, OH · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This ...

Elevance Health

Nurse Reviewer 1

Miami, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Elevance Health

Nurse Reviewer 1

Grand Prairie, TX · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This ...

Elevance Health

Nurse Reviewer 1

Tampa, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This ...

Elevance Health

Nurse Reviewer 1

Wilmington, DE · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This ...

Elevance Health

Nurse Reviewer 1

Atlanta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This ...

Elevance Health

Nurse Reviewer 1

Tampa, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and ...

Zelis

Clinical Nurse Reviewer

Atlanta, GA · On-site

$59K - $75K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing ...

Zelis

Clinical Nurse Reviewer

Boston, MA · On-site

$59K - $75K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing ...

Elevance Health

Nurse Reviewer 1

Tampa, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This ...

Zelis

Clinical Nurse Reviewer

Saint Louis, MO · On-site

$59K - $75K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing ...

Zelis

Clinical Nurse Reviewer

Plano, TX · On-site

$59K - $75K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing ...

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All JobsNurse Reviewer Jobs

Nurse Reviewer information

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$28

$37

$42

How much do nurse reviewer jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for nurse reviewer in the United States is $37.04, according to ZipRecruiter salary data. Most workers in this role earn between $34.13 and $41.35 per hour, depending on experience, location, and employer.

What is a nurse reviewer?

A Nurse Reviewer is a registered nurse who evaluates medical records, claims, and treatment plans to ensure that healthcare services are medically necessary, appropriate, and compliant with policies or regulations. They often work for insurance companies, government agencies, or healthcare organizations, reviewing clinical documentation and making recommendations about coverage or care. Nurse Reviewers play a vital role in utilization management, quality assurance, and preventing healthcare fraud. Their assessments help manage costs while ensuring patients receive proper care.

What are some typical challenges nurse reviewers face when coordinating with healthcare providers and insurance companies?

Nurse Reviewers often encounter challenges such as balancing the need to advocate for patient care with adhering to insurance guidelines and policies. They must communicate complex medical information clearly to both healthcare providers and insurance representatives, sometimes dealing with time-sensitive cases or incomplete documentation. Effectively managing these interactions requires strong organizational skills, attention to detail, and the ability to navigate differing priorities while maintaining professionalism and empathy.

What is the difference between Nurse Reviewer vs Nurse Auditor?

AspectNurse ReviewerNurse Auditor
CredentialsRegistered Nurse (RN) license, often with clinical experienceRegistered Nurse (RN) license, with additional auditing or compliance training
Work EnvironmentHealthcare facilities, insurance companies, or third-party review organizationsInsurance companies, healthcare organizations, or consulting firms
Primary ResponsibilitiesReview patient records for medical necessity and quality of careAudit claims and documentation for billing accuracy and compliance

While both Nurse Reviewers and Nurse Auditors have clinical backgrounds and work in healthcare settings, Nurse Reviewers primarily evaluate patient records for quality and necessity, whereas Nurse Auditors focus on financial and billing compliance. The roles often overlap but serve different aspects of healthcare quality and financial integrity.

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

To thrive as a Nurse Reviewer, you need a strong clinical background, analytical skills, and an active RN license, often complemented by experience in utilization review or case management. Familiarity with medical coding systems (such as ICD-10 and CPT), electronic health records (EHRs), and utilization management software is typically required. Excellent written communication, critical thinking, and attention to detail are vital soft skills that contribute to effective documentation and fair assessment of cases. These abilities ensure accurate and efficient review of medical records, compliance with policies, and optimal patient outcomes.

How to become a nurse reviewer?

To become a nurse reviewer, you typically need a valid registered nurse (RN) license and several years of clinical nursing experience. Strong attention to detail, excellent communication skills, and familiarity with medical documentation are essential, and some roles may require knowledge of medical coding or health information systems.
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Nurse Reviewer jobs near you
Infographic showing various Nurse Reviewer job openings in the United States as of August 2026, with employment types broken down into 86% Full Time, and 14% Part Time. Highlights an 71% In-person, and 29% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.

Nurse Reviewer 1

Elevance Health

Remote

Other

Posted 13 days ago

Elevance Health rating

7.7

Company rating: 7.7 out of 10

Based on 351 frontline employees who took The Breakroom Quiz

204th of 308 rated insurance

Job description

Nurse Reviewer 1

Nurse Reviewer 1

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Work Schedule: Tuesday- Saturday OR Sunday - Thursday; 8:00a - 5:00p local time.

Training Schedule: Monday - Friday; 8:00a - 4:30p CST for at least 3 weeks.

The Nurse Reviewer 1 is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with more senior colleagues to complete non-routine reviews. Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization requests to assess the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment.

How you will make an impact:

  • Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
  • Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.
  • Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
  • Follows-up to obtain additional clinical information.
  • Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics.

Minimum Requirements:

Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required.

Preferred Skills, Capabilities and Experiences:

  • BA/BS degree preferred.
  • Familiarity with Utilization Management Guidelines, ICD-10 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
  • Previous utilization and/or quality management and/or call center experience preferred.

Job Level: Non-Management Non-Exempt

Workshift: Job Family: MED > Licensed Nurse

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

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