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Massgeneralbrigham

Senior Nurse Reviewer

Somerville, MA · Remote

$79K - $115K/yr

Job Summary The Senior Nurse Reviewer is responsible for the coordination, facilitation, and appeal of the clinical components of charge audits and forensic review findings. This includes audits ...

Zimmerman Associates Inc.

$23.56/hr

Referral Management (Non-Nurse) Reviewers will facilitate centralized product line and specialty referrals for Active-Duty Service Members and TRICARE Prime beneficiaries enrolled at Military ...

Regal Medical Group

Reviewer, Clinical RN

Canoga Park, CA · On-site

$45 - $50/hr

Clinical Nurse Reviewer The Clinical Nurse Reviewer is focus on auditing the IP UM process and identifying process improvement measures to assist in meeting regulatory requirements and maintaining ...

Mass General Brigham

Senior Nurse Reviewer

Somerville, MA · On-site +1

$79K - $115K/yr

Job Summary The Senior Nurse Reviewer is responsible for the coordination, facilitation, and appeal of the clinical components of charge audits and forensic review findings. This includes audits ...

Regal Medical Group, Inc.

$45 - $50/hr

The Clinical Nurse Reviewer is focus on auditing the IP UM process and identifying process improvement measures to assist in meeting regulatory requirements and maintaining compliance with the ...

Care Navigators On Demand

We currently have an opening for Clinical Nurse Reviewer The Clinical nurse reviewer will specifically run analysis on this line of business and review with the Regional Medical Director(s) high cost ...

Centers Home

PR

Revival Home Health Care is seeking a detail-oriented Registered Nurse to join our dynamic clinical team as an OASIS Reviewer. In this vital role, you will be responsible for reviewing and validating ...

US Government Jobs

Nurse

Washington, DC

Nurse Clinical Nurse Reviewer This position serves as a nurse functioning in the role of a clinical nurse reviewer within the program management office, veteran and family member programs directorate ...

Centers Home

OASIS Reviewer

Pompano Beach, FL

Revival Home Health Care is seeking a detail-oriented Registered Nurse to join our dynamic clinical team as an OASIS Reviewer. In this vital role, you will be responsible for reviewing and validating ...

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Nurse Reviewer information

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How much do nurse reviewer jobs pay per hour?

As of Jun 15, 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.

How to be a nurse reviewer?

To become a nurse reviewer, you typically need a valid nursing license and several years of clinical experience. Strong attention to detail, good communication skills, and familiarity with medical documentation or research are important, and some roles may require knowledge of healthcare regulations or certification in medical review processes.

How to make an extra $1000 a month as a nurse?

Nurse reviewers can increase their income by taking on freelance or per diem review assignments, which often pay per case or hour. Developing specialized skills or certifications, such as in legal or insurance reviews, can also command higher rates and help reach the extra income goal.

How to become a chart review nurse?

To become a chart review nurse, you typically need a registered nurse (RN) license and experience in clinical nursing or medical record review. Additional certifications such as Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS) can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

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

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.

What is the best side hustle for nurses?

Nurses can pursue side hustles such as telehealth consulting, medical writing, or health coaching, which leverage their clinical knowledge and healthcare skills. These options often offer flexible schedules and can be done remotely, making them suitable for busy nursing professionals.
More about Nurse Reviewer jobs
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Nurse Reviewer jobs near you
Infographic showing various Nurse Reviewer job openings in the United States as of June 2026, with employment types broken down into 8% Locum Tenens, 72% As Needed, 12% Full Time, 4% Temporary, and 4% Nights. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.

Senior Nurse Reviewer

Massgeneralbrigham

Somerville, MA • Remote

$79K - $115K/yr

Full-time

Posted 5 days ago

Job description

Site: Mass General Brigham Incorporated


Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.


Job Summary

The Senior Nurse Reviewer is responsible for the coordination, facilitation, and appeal of the clinical components of charge audits and forensic review findings. This includes audits conducted at Mass General Brigham (MGB) facilities in accordance with the MGB Charge Audit Policy and established departmental policies/procedures. The Senior Nurse Reviewer plays an important role in appealing challenges to charging policy and practice. The increased use of pre- and post-payer audits impacts MGB net revenue, to which the incumbent responds.
Essential Functions
-Coordinates the scheduling of audits with external third-party audit representatives/payors to initiate the audit process.
-Prepares detailed packages for cases selected by audit representatives, including necessary documents needed to initiate the audit process.
-Prepares audit responses and appeals for complex charge and forensic audits.
-Documents, summarizes, and defends audit findings in a clear, concise, and effective manner to preserve MGB appeal rights.
-Conducts post-audit research to support and defend cited charges by obtaining additional documentation.
-Updates internal systems used for tracking and reporting findings, including but not limited to patient accounting systems, spreadsheets, and databases, to facilitate monthly management reporting.
-Provides subject matter knowledge on various billing, coding, and clinical topics to the audit representatives and other key customers as needed.


Qualifications

  • Bachelor's Degree in Nursing required

  • Registered Nurse [RN - MA State License] - required

  • 3+ years of experience in clinical nursing required

  • 2+ years of experience in a quality assurance or clinical review role required


Skill for Success

  • It is essential that the candidate possesses strong appeal writing experience, as this skill is critical for successfully supporting and defending clinical charge audit findings during the appeals process.

  • Strong analytical skills with the ability to interpret clinical data and identify trends.

  • Excellent communication and interpersonal skills, with the ability to collaborate effectively with multidisciplinary teams.

  • Proficient in electronic health record (EHR) systems and clinical documentation tools.

  • Strong organizational skills and attention to detail.

  • Ability to provide constructive feedback and facilitate training for nursing staff.

Working schedule:

  • Remote, M-F eastern standard business hours. Requires a quiet, secure, HIPAA-compliant working station


Additional Job Details (if applicable)


Remote Type

Remote


Work Location

399 Revolution Drive


Scheduled Weekly Hours

40


Employee Type

Regular


Work Shift

Day (United States of America)


Pay Range

$79,560.00 - $115,720.80/Annual


Grade

7


At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.


EEO Statement:

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.


Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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