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Nurse Reviewer Jobs (NOW HIRING)

Gainwell Technologies

$95 - $110/hr

DRG Nurse Reviewer Appeals and Hearings- Remote Date: Aug 30, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that ...

New

Gainwell Technologies

NY · On-site

$95 - $110/hr

DRG Nurse Reviewer Appeals and Hearings- Remote Date: Aug 30, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that ...

New

Peraton

$66 - $106/hr

At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. * Current/Active ...

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 ...

Triwill Group

$70 - $85/hr

Medical Reviewer, RN Location: Remote Salary: $70,000-85,000 annually, based on years of experience About J29 J29, Inc. (J29) has been supporting commercial, State, and Federal health and human ...

Centers Home

OASIS Reviewer

Margate, FL · On-site

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 ...

ISLAND PEER REVIEW CORP

Health Services Reviewer

Albany, NY · On-site

$40.38 - $43.46/hr

Computer proficiency with the ability to learn and understand new review programs and monitoring ... Registered Professional Nurse (RN). Currently licensed and registered in New York State, required.

Centers Home

OASIS Reviewer

San Juan, PR · On-site

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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How much do nurse reviewer jobs pay per hour?

As of Sep 6, 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 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.

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 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 review software.
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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 70% Full Time, 15% Part Time, and 15% Contract. Highlights an 38% In-person, 8% Hybrid, and 54% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.

PRN Utilization Review Nurse Reviewer

Dane Street, LLC

Remote

Full-time, Per diem

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 8 days ago

Job description

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments.
Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways.
Our PRN Nursing Program is designed for flexible, as-needed staffing to support our team during peak times, weekends, and holidays.
  • PRN nurses will be required to work at least one weekend per month, one major holiday, and one minor holiday per year.
  • A minimum number of shifts per month will be mandated to ensure that PRN nurses maintain their QA skills and familiarity with processes.

MAJOR DUTIES & RESPONSIBILITIES
  • Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
  • Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
  • Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
  • Input and manage essential clinical details within various medical management platforms.
  • Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
  • Apply clinical reasoning to determine the suitable evidence-based guidelines.
  • Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements
  • Proficient in both written and spoken communication.
  • Capable of maintaining professional communication with physicians and clients.
  • Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
  • Possesses a keen organizational sense and pays close attention to details.
  • Adept at resolving intricate and multifaceted problems.
  • Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
  • Background in medical or clinical practice through education, training, or professional engagement.
  • Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Additional Duties
  • May provide oversight to the work of the team members.
  • Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction.
  • Responsible for the final approval on cases for release to the client.
  • Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.

EDUCATION/CREDENTIALS:
Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.
JOB RELEVANT EXPERIENCE:
2 yrs minimum clinical nursing experience is required.
One year of previous experience in Utilization Management is required.
JOB RELATED SKILLS/COMPETENCIES:
Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.
WORK FROM HOME TECHNICAL REQUIREMENTS:
Supply and support their own internet services.
Maintaining an uninterrupted internet connection is a requirement of all work from home position.
Requirements
Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.
Our Commitment:
We are committed to providing fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees.
Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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