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Rn Clinical Reviewer Jobs (NOW HIRING)

IPRO

Clinical Reviewer (RN)

Jericho, NY · On-site

$38.46 - $43.27/hr

Clinical Reviewer (RN) As a Clinical Reviewer (RN), you will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. You will utilize your knowledge and ...

Nexus Health Systems Ltd

Clinical Reviewer

Houston, TX · On-site

The Clinical Reviewer reviews medical records, clinical histories, assessments, and referral ... We are specifically seeking an experienced Registered Nurse (RN) or Nurse Practitioner (NP) with ...

Nexus Health Systems, Inc.

$100 - $125/hr

Clinical Reviewer Full Time Professional Houston, TX, US 2 days ago Requisition ID: 2175 Clinical ... We are specifically seeking an experienced Registered Nurse (RN) or Nurse Practitioner (NP) with ...

Comagine

Clinical Reviewer RN - Alabama

Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality ...

Palo Verde Community College District

$100 - $125/hr

Position Overview We are seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess the medical necessity and quality of healthcare services through prospective, concurrent, and ...

Virtix Health LLC

Clinical Quality Reviewer

Active clinical licensure (RN) * Demonstrated experience reviewing clinical documentation for medical necessity and appropriateness of care. * Working knowledge of CPT and ICD-10 coding. * Ability to ...

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Rn Clinical Reviewer information

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How much do rn clinical reviewer jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for rn clinical reviewer in the United States is $35.92, according to ZipRecruiter salary data. Most workers in this role earn between $31.25 and $40.38 per hour, depending on experience, location, and employer.

What is an RN Clinical Reviewer?

RN Clinical Reviewers are registered nurses who evaluate medical records and clinical documentation to ensure compliance with healthcare regulations and standards. They review patient cases, analyze treatment plans, and determine the medical necessity of services provided. This role often involves working with insurance companies, healthcare providers, or hospitals to ensure accurate and appropriate care. RN Clinical Reviewers use their clinical expertise to assess the quality and efficiency of patient care, helping to improve healthcare outcomes and reduce unnecessary costs.

What are the key skills and qualifications needed to thrive as an RN Clinical Reviewer?

To thrive as an RN Clinical Reviewer, you need a current RN license, strong clinical judgment, and experience in healthcare settings, often supported by a BSN or higher degree. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory standards like CMS and HIPAA is typically required. Excellent analytical skills, attention to detail, and effective written and verbal communication set top performers apart. These skills ensure accurate clinical review, regulatory compliance, and clear communication with healthcare providers, which are vital for high-quality patient care and efficient case management.

What are some common challenges faced by RN Clinical Reviewers, and how can they be navigated successfully?

RN Clinical Reviewers often encounter challenges such as managing a high volume of case reviews within tight deadlines and staying current with evolving healthcare regulations and payer guidelines. To navigate these challenges, strong organizational skills, attention to detail, and effective communication with multidisciplinary teams are essential. Many reviewers also benefit from ongoing professional development and collaboration with peers to ensure consistent and accurate clinical assessments.

What is the difference between Rn Clinical Reviewer vs Rn Case Manager?

AspectRn Clinical ReviewerRn Case Manager
CredentialsRegistered Nurse (RN), often with certifications in case management or clinical reviewRegistered Nurse (RN), with case management certification often preferred
Work EnvironmentHealthcare organizations, insurance companies, or third-party review agenciesHospitals, clinics, insurance companies, or community health settings
Primary FocusReview medical records, ensure compliance, and evaluate care for appropriatenessCoordinate patient care, advocate for patients, and manage treatment plans
Common TasksClinical review, documentation, and compliance checksPatient assessments, care planning, and resource coordination

While both roles require RN credentials and involve patient care, Rn Clinical Reviewers focus on evaluating medical records and ensuring compliance, whereas Rn Case Managers coordinate patient care and advocate for treatment needs. The roles often overlap but serve different primary functions within healthcare organizations.

How to become a registered nurse clinical reviewer?

To become a registered nurse clinical reviewer, you typically need to hold an active registered nurse (RN) license, gain clinical experience in a healthcare setting, and develop knowledge of medical records and insurance processes. Additional certifications in case management or healthcare quality, along with strong analytical and communication skills, can enhance eligibility for this role.

How to become an RN clinical reviewer?

To become an RN clinical reviewer, one typically needs a valid registered nurse license and several years of clinical experience. Additional qualifications may include familiarity with medical records, coding, and documentation, as well as strong analytical skills; some employers also prefer certifications in case management or health information management.
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Rn Clinical Reviewer jobs near you
Infographic showing various Rn Clinical Reviewer job openings in the United States as of September 2026, with employment types broken down into 3% As Needed, 74% Full Time, 16% Part Time, and 7% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.

RN Clinical Reviewer

Albany, NY • On-site

Greenlife Healthcare Staffing
Recruiting and Staffing Services • 11 - 50 employees
Learn more about Greenlife Healthcare Staffingexternal

$60/hr

Full-time

Medical

Re-posted 7 days ago

Job description

RN Clinical Reviewer – Jericho or Albany, NY

Location: Jericho or Albany, NY
Employment Type: Full-time (5 days/week)
Pay: $60/hour

Position Overview:
We are seeking a meticulous Clinical Reviewer Registered Nurse. Working under the direction of the team supervisor, you'll perform clinical reviews and abstractions of assigned cases related to maternal deaths or adverse events occurring during outpatient surgical procedures. This role is ideal for an experienced RN with a strong OB/maternal health background and a passion for quality improvement and patient safety.

Why You'll Love Working Here:
  • Competitive pay of $60/hour.
  • 5 sick days (40 hours), per the NYS Paid Sick Leave Act.
  • Health insurance (subject to plan eligibility).
  • Full-time, 5 days per week.
  • The opportunity to conduct high-stakes clinical reviews for the NYS Department of Health, enhancing your expertise in quality improvement and maternal health.
  • Meaningful work identifying and analyzing critical events in maternal care and outpatient surgical procedures.

Qualifications:
  • Baccalaureate degree in Nursing, or graduate of an approved Registered Professional Nurse training program.
  • Current licensure as a Registered Professional Nurse in New York State.
  • Minimum 4 years of clinical practice experience in a facility or community-based setting, including medical, surgical, and/or obstetrical experience.
  • Minimum 2 years of acute care hospital experience.
  • OB/maternal health background (required).
  • Experience reviewing charts for quality improvement or utilization review in an acute or ambulatory care facility (preferred).
  • Knowledge of current disease/care management and coordination trends (preferred).
  • Strong analytical and written/verbal communication skills.
  • Able to work independently and in a team, and to prioritize reviews and projects.
  • Proficient with standard office technology and Microsoft Word and Excel.
  • Able to gather and analyze information from records, reports, and other sources.

Key Responsibilities:
  • Conduct clinical reviews of medical records from a variety of sources, along with other documents crucial to the review.
  • Develop and draft narrative summaries of clinical reviews in the form(s) required by the NYS Department of Health.
  • Track case status in Excel and other required databases.
  • Other activities as needed in response to the changing needs of the department.

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About Greenlife Healthcare Staffing

Sourced by ZipRecruiter

Greenlife Healthcare Staffing is a nationwide recruitment agency, matching both new grads and advanced practitioners to hospitals, clinics, nursing homes, multi-specialty groups, and private practices.

Industry

Recruiting and staffing services

Company size

11 - 50 Employees

Headquarters location

New York, NY, US

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