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Professional Review Nurse Jobs (NOW HIRING)

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... With over 20 years of experience connecting organizations with highly qualified professionals ...

Moffitt

$77K - $117K/yr

Summary The Utilization Review Nurse is responsible for performing initial, concurrent, and ... We seek candidates whose skills, and personal and professional experience, have prepared them to ...

Actalent

Clinical Concurrent Review Nurse

Phoenix, AZ · On-site

Work Environment The role operates in a professional clinical and administrative setting focused on utilization management and concurrent review of inpatient acute and post-acute care. Nurses in this ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

Review clinical content of medical records * Participate in treatment team meetings * Collaborate ... Registered Nurse (RN) preferred or License Professional Nurse (LPN) * Current GA or Multistate ...

UHS

Utilization Review Nurse (RN)

Augusta, GA

Review clinical content of medical records * Participate in treatment team meetings * Collaborate ... Registered Nurse (RN) preferred or License Professional Nurse (LPN) * Current GA or Multistate ...

Hunterdon Health

Documentation Review Nurse

Flemington, NJ · On-site

$93K - $116K/yr

Documentation Review Nurse Position Summary The Documentation Review Nurse will apply expertise and ... Work closely with coding professionals to address discrepancies and clarify documentation for ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

Review clinical content of medical records * Participate in treatment team meetings * Collaborate ... Registered Nurse (RN) preferred or License Professional Nurse (LPN) * Current GA or Multistate ...

ePATHUSA Inc

Medical Review Nurse

VA · Remote

Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews ... Provides professional assessment, planning, coordination, implementation, and reporting of complex ...

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Professional Review Nurse information

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$15

$38

$72

How much do professional review nurse jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for professional review nurse in the United States is $38.50, according to ZipRecruiter salary data. Most workers in this role earn between $27.88 and $42.79 per hour, depending on experience, location, and employer.

What is a professional review nurse?

Professional Review Nurses are registered nurses who specialize in evaluating patient care, medical records, and healthcare services to ensure quality and compliance with regulations. They assess the necessity, appropriateness, and efficiency of medical treatments and procedures, often for insurance companies, hospitals, or healthcare organizations. Their work helps control healthcare costs and ensures patients receive suitable care according to established guidelines. Professional Review Nurses also play a key role in utilization review and case management.

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

To thrive as a Professional Review Nurse, you need a current RN license, strong clinical assessment skills, and a thorough understanding of healthcare regulations and medical terminology. Familiarity with utilization management software, electronic medical records (EMRs), and case management tools is typically required. Excellent analytical thinking, attention to detail, and effective written and verbal communication are crucial soft skills for success in this role. These competencies ensure accurate case reviews, compliance with healthcare standards, and clear communication with providers and insurers.

What are some common challenges faced by professional review nurses when evaluating medical necessity for insurance claims?

Professional Review Nurses often encounter challenges such as navigating complex medical records, keeping up with changing healthcare regulations, and managing tight review deadlines. They must carefully balance clinical judgment with insurance guidelines to ensure fair and accurate determinations. Clear communication with physicians, case managers, and insurance representatives is essential, as misunderstandings can delay claim processing or lead to appeals. Adapting to evolving technology platforms and maintaining up-to-date knowledge of evidence-based practices are also key aspects of the role.

What is the difference between Professional Review Nurse vs Case Manager Nurse?

AspectProfessional Review NurseCase Manager Nurse
CredentialsRN license, certification in review or utilization managementRN license, certification in case management or utilization review
Work EnvironmentReviewing medical records, insurance claims, and provider documentationCoordinating patient care, managing treatment plans, liaising with providers
Employer & IndustryInsurance companies, utilization review organizations, healthcare agenciesHospitals, insurance companies, healthcare organizations

Professional Review Nurses primarily focus on evaluating medical records and insurance claims to ensure appropriate care and coverage. In contrast, Case Manager Nurses coordinate patient care, develop treatment plans, and facilitate communication among healthcare providers. Both roles require RN licensure and relevant certifications but differ in daily responsibilities and work settings.

How to become a professional review nurse?

To become a professional review nurse, you typically need to earn a nursing degree such as an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN), pass the NCLEX-RN licensing exam, and gain clinical experience. Additional certifications in case management or healthcare review can enhance qualifications for roles involving medical record review and quality assurance.
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Professional Review Nurse jobs near you
Infographic showing various Professional Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 22% Part Time, and 4% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $80,071 per year, or $38.5 per hour.

Utilization Review Nurse

Medix

Southfield, MI • On-site

$42 - $46/hr

Part-time

Medical, Dental, Vision, Retirement

Re-posted 2 days ago

Job description

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a Utilization Review Nurse to manage the full lifecycle of Independent Review Organization (IRO) cases. The primary responsibilities include reviewing clinical documentation, performing quality assurance on physician reports, and collaborating with various teams to ensure accurate and timely case handling.
Key Responsibilities
  • Manage the full lifecycle of IRO cases from intake through final case closure.
  • Review incoming clinical documentation, verify completeness, and prepare concise case summaries for physician reviewers.
  • Coordinate and route cases to the appropriate physician specialty while managing requests for additional medical records.
  • Perform quality assurance on physician reports to ensure accuracy, clarity, completeness, and defensibility.
  • Monitor regulatory deadlines and case status to ensure timely, compliant case completion.
  • Maintain accurate case tracking and documentation within internal systems and state IRO programs.
  • Collaborate with physicians, clients, and internal teams to resolve documentation gaps and support case progression.
  • Contribute to workflow improvements, new state program implementation, and process optimization as the organization grows.

Qualifications
  • Active RN license and BSN required.
  • Experience with Independent Review Organizations (IROs), or Utilization Review/Appeals within a Health Plan or TPA.
  • Strong clinical documentation review, case summary writing, and QA skills.
  • Excellent written communication with exceptional attention to detail.
  • Ability to independently manage multiple cases while meeting regulatory timelines.

Skills
  • Technical: Proficiency in clinical documentation review and case summary writing.
  • Soft: Strong written communication, attention to detail, and independent case management skills.

Benefits
  • Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
  • Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
  • 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
  • Short Term Disability Insurance.
  • Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
Any required state or Joint Commission training is compensated at the state or local minimum wage rate.
* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
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About Medix Staffing Solutions

Sourced by ZipRecruiter

Since 2001, we’ve been dedicated to helping you achieve your goals. Medix was created to become a leading provider of workforce solutions for clients and candidates across the healthcare and life sciences industries. Today, we are that leader. Headquartered in Chicago, we have 23 offices across the United States, and staff talent around the world. Medix is committed to fulfilling our core purpose as an organization: to positively impact the lives of our talent, clients, and teammates through employment, philanthropy, and opportunity. The combination of purpose and values has nurtured our thriving culture that encourages our internal team to excel at work and in everyday life.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

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