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Rn Medical Reviewer Jobs (NOW HIRING)

InGenesis

RN / Medical Reviewer / Remote

RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review Employment Type : Full Time City : Columbia State : SC Pay Range : InGenesis is ...

J29

Medical Reviewer, RN

Medical Reviewer, RN J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as an employee-centered healthcare management ...

New

Empower AI

Medical Reviewer III (Medicare/DME)

Medical Review Specialist III As a casual Medical Review Specialist III (Medical Reviewer III) for ... Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform ... Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR ...

Empower AI

Medical Reviewer III (Medicare/DRG)

Medical Review Specialist III (Medicare DRG) Empower AI gives federal agency leaders the tools to ... Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform ... Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medical Reviewer III) you will primarily perform ... Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medical Reviewer III) you will primarily perform ... Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will ... Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR ...

J29 Inc.

Medical Reviewer, RN

Millersville, MD · On-site +1

Medical Reviewer, RN About J29 J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as an employee-centered healthcare ...

Peraton

Nurse Reviewer - Medicaid

Reston, VA · On-site

$66K - $106K/yr

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 ...

Peraton

Nurse Reviewer - Medicaid

Herndon, VA · On-site

$66K - $106K/yr

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 ...

Swoop

Freelance Medical Reviewer, MyHealthTeam

$20 - $75/hr

Our medical reviewers ensure the accuracy of information like symptoms and treatments of a ... Registered dietitians * Psychologists * Professionals who can meet a deadline * Professionals who ...

Peraton

Nurse Reviewer - Medicaid

$66K - $106K/yr

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 ...

Ourhrconnect

Reviewer I, Medical

Myrtle Beach, SC · On-site

Summary Performs medical reviews using established criteria sets and/or performs utilization ... Active, unrestricted RN licensure from the United States and in the state of hire, OR, active ...

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All JobsRn Medical Reviewer Jobs

Rn Medical Reviewer information

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$37

$42

How much do rn medical reviewer jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for rn medical 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.

How does an RN Medical Reviewer collaborate with other healthcare professionals?

As an RN Medical Reviewer, collaboration with physicians, pharmacists, and administrative staff is essential to ensure comprehensive and accurate case evaluations. You may participate in multidisciplinary meetings, clarify clinical details with treating providers, and consult with subject matter experts to support your medical necessity determinations. Strong communication skills are vital, as you’ll often be responsible for relaying review outcomes and discussing complex cases with both clinical and non-clinical team members. This collaborative approach helps maintain high standards of patient care and regulatory compliance.

What skills and qualifications are needed to be an RN Medical Reviewer?

To thrive as an RN Medical Reviewer, you need a nursing degree with an active RN license, strong clinical judgment, and experience in chart review or utilization management. Familiarity with medical coding systems, case management software, and healthcare regulations, along with certifications such as CCM or URAC, is often required. Attention to detail, analytical thinking, and effective written communication are crucial soft skills for evaluating medical records and conveying findings. These skills ensure accurate, compliant, and timely review processes that support quality patient care and organizational standards.

How to become an RN medical reviewer?

To become an RN medical reviewer, you typically need a valid registered nurse (RN) license, relevant clinical experience, and knowledge of medical documentation and insurance processes. Additional certifications in case management or medical review can enhance qualifications, and familiarity with electronic health records (EHR) systems is often required.

What is an RN Medical Reviewer?

RN Medical Reviewers are registered nurses who evaluate medical records, claims, and documentation to ensure accuracy, compliance, and quality of care. They use their clinical knowledge to review patient cases, verify the necessity of medical treatments, and ensure healthcare services meet established guidelines. RN Medical Reviewers often work for insurance companies, government agencies, or healthcare organizations and play a critical role in preventing fraud and ensuring proper healthcare delivery.

What does an RN medical reviewer do?

An RN medical reviewer evaluates medical records, claims, and documentation to ensure accuracy and compliance with healthcare standards. They review patient information, assess medical necessity, and may work with insurance companies or healthcare providers to validate claims, often using electronic health record systems and requiring nursing licensure. Their role helps ensure proper claim processing and adherence to medical guidelines.

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

AspectRn Medical ReviewerRn Case Manager
CredentialsRegistered Nurse (RN), often with clinical review certificationsRegistered Nurse (RN), with case management or care coordination certifications
Work EnvironmentInsurance companies, healthcare review organizations, telehealthHospitals, clinics, insurance companies, community health
Employer & IndustryInsurance, healthcare review, telehealthHealthcare providers, insurance, community health
Primary FocusReview medical records, determine coverage, ensure complianceCoordinate patient care, manage treatment plans, facilitate communication

While both roles require RN credentials and involve healthcare settings, Rn Medical Reviewers focus on evaluating medical records and insurance coverage, whereas Rn Case Managers coordinate patient care and treatment plans. Understanding these differences helps job seekers identify the right career path in healthcare and insurance industries.

More about Rn Medical Reviewer jobs
What cities are hiring for Rn Medical Reviewer jobs? Cities with the most Rn Medical Reviewer job openings:
What states have the most Rn Medical Reviewer jobs? States with the most job openings for Rn Medical Reviewer jobs include:
What job categories do people searching Rn Medical Reviewer jobs look for? The top searched job categories for Rn Medical Reviewer jobs are:
Rn Medical Reviewer jobs near you
Infographic showing various Rn Medical Reviewer job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.

RN / Medical Reviewer / Remote

InGenesis

Remote

Other

Re-posted 16 days ago

Job description

RN / Medical Reviewer / Remote
Job Details
Professional Discipline : Registered Nurse
Specialty : Utilization Review
Employment Type : Full Time
City : Columbia
State : SC
Pay Range :
Job Description:
InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria and assess and monitor medical necessity using your clinical proficiency and claims knowledge.
This is a REMOTE opportunity for candidates living in the state of South Carolina! Apply today and we'll reach out to answer any questions you may have.
Job Duties
  • Perform medical review/authorization process.
  • Ensure coverage for appropriate services within benefit and medical necessity guidelines.
  • Assess service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans.
  • Evaluate outcomes of plans, eligibility, level of benefits, place of service, length of stay and medical necessity regarding requested services and benefit.
  • Ensure accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits.
  • Utilize allocated resources to back up review determinations.
  • Identify and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).
  • Participate in data collection/input into system for clinical information flow and proper claims adjudication
  • Perform other duties as assigned.
Minimum Qualifications
  • Current Registered Nurse / RN license in the State of South Carolina.
  • Associates degree in nursing or graduate from accredited nursing school.
  • 4 years of clinical experience in specialty areas like: oncology, cardiology, neonatology, maternity, rehab, mental health/chemical dependency or surgery. OR
  • 4 years of utilization review/case management or combination of clinical experience.

EEO Statement:
InGenesis is an equal opportunity employer committed to fostering a diverse, inclusive, and equitable workplace. We comply with all applicable federal, state, and local employment laws, including recent executive orders, and strictly prohibit discrimination, harassment, or retaliation based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, genetic information, age, veteran status, or any other characteristic protected by law.
InGenesis is dedicated to making reasonable accommodations for qualified individuals with disabilities and ensuring that all employment decisions are based on qualifications, merit, and business needs. If you require a reasonable accommodation during the hiring process, please contact us by visiting our website at https://www.ingenesis.com/careers/site-accommodations.
To learn more about your rights, please refer to the Know Your Rights: Workplace Discrimination is Illegal poster issued by the U.S. Equal Employment Opportunity Commission (EEOC).
Company Statement:
With decades of experience, InGenesis has grown into one of North America's most trusted Healthcare Services Firms, which includes comprehensive health and workforce solutions. As the industry landscape shifts with new challenges in patient care, quality and compliance requirements, workforce retention, and operational efficiencies, we deliver strategic, data-driven solutions that include redefining workforce management and clinical service delivery. Explore InGenesis to discover how our expertise, innovative strategies, and commitment to excellence are shaping the future of healthcare workforce solutions. Join us in celebrating the professionals who define the next era of healthcare.

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