1

Rn Medical Reviewer Jobs in Puerto Rico (NOW HIRING)

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 ...

Registered Nurse

Aibonito, PR

  • Medical

  • Dental

  • Vision

  • Retirement

Key Responsibilities Provide direct patient care in medical surgical, critical care, perioperative ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

Registered Nurse

Adjuntas, PR

  • Medical

  • Dental

  • Vision

  • Retirement

Key Responsibilities Provide direct patient care in medical surgical, critical care, perioperative ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

Registered Nurse

Aguadilla, PR

  • Medical

  • Dental

  • Vision

  • Retirement

Key Responsibilities Provide direct patient care in medical surgical, critical care, perioperative ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

Registered Nurse

Arroyo, PR

  • Medical

  • Dental

  • Vision

  • Retirement

Key Responsibilities Provide direct patient care in medical surgical, critical care, perioperative ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

Registered Nurse

Aguirre, PR

  • Medical

  • Dental

  • Vision

  • Retirement

Key Responsibilities Provide direct patient care in medical surgical, critical care, perioperative ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

Registered Nurse

Aguada, PR

  • Medical

  • Dental

  • Vision

  • Retirement

Key Responsibilities Provide direct patient care in medical surgical, critical care, perioperative ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

Registered Nurse

Arecibo, PR

  • Medical

  • Dental

  • Vision

  • Retirement

Key Responsibilities Provide direct patient care in medical surgical, critical care, perioperative ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

Registered Nurse

San Antonio, PR

  • Medical

  • Dental

  • Vision

  • Retirement

Key Responsibilities Provide direct patient care in medical surgical, critical care, perioperative ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

Registered Nurse

Arecibo, PR · On-site

$41 - $56/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Registered Nurse (RN) - Dialysis (ICHD) DaVita is seeking a Experienced Registered Nurse (RN) to ... Medical, dental, vision, and 401(k) match. * Paid time off and PTO cash-out. * Family support: EAP ...

Registered Nurse

San Antonio, PR · On-site

$41 - $56/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Registered Nurse (RN) - Dialysis (ICHD) Employment Type: Full-Time Schedule: Three (3) Days Per ... Medical, dental, vision, 401(k) with match. * Paid time off and PTO cash out. * Parental leave ...

Registered Nurse

San Juan, PR

$35 - $49/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

DaVita is seeking a Registered Nurse to join our outpatient dialysis team. In this role, you'll ... Medical, dental, vision, and 401(k) match * Paid time off and PTO cash-out * Family support: EAP ...

Registered Nurse

Bajadero, PR

$41 - $56/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Minimum 1 year of RN experience preferred to ensure independent clinical practice. DaVita is ... Medical, dental, vision, and 401(k) match * Paid time off and PTO cash-out * Family support: EAP ...

Registered Nurse

Bajadero, PR · On-site

$41 - $56/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Minimum 1 year of RN experience preferred to ensure independent clinical practice. DaVita is ... Medical, dental, vision, and 401(k) match * Paid time off and PTO cash-out * Family support: EAP ...

Registered Nurse

San Juan, PR

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Registered Nurse Career Opportunity Encompass Health: Where Nursing Meets Heart, Home, and Healing ... Affordable medical, dental, and vision plans for both full-time and part-time employees and their ...

Registered Nurse

San Juan, PR

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

As a DaVita RN, you'll ensure compassionate and professional delivery of all dialysis-related ... Medical, dental, vision, 401(k) with match * Paid time off and PTO cash out * Parental leave ...

Registered Nurse

Fort Buchanan, PR · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

As a DaVita RN, you'll ensure compassionate and professional delivery of all dialysis-related ... Medical, dental, vision, 401(k) with match * Paid time off and PTO cash out * Parental leave ...

Registered Nurse

San Juan, PR

$35 - $49/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Training may occur at a clinic other than your home location Qualifications: * RN license in the ... Medical, dental, vision, and 401(k) match * Paid time off and PTO cash-out * Family support: EAP ...

next page

Showing results 1-20

Rn Medical Reviewer information

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 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 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 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.

How to become an RN medical reviewer?

To become an RN medical reviewer, you typically need a valid registered nurse license, relevant clinical experience, and knowledge of medical documentation and coding. Many employers also prefer candidates with experience in case management, insurance, or healthcare compliance. Continuing education or certifications in medical review or healthcare quality can enhance job prospects.

What are popular job titles related to Rn Medical Reviewer jobs in Puerto Rico?

For Rn Medical Reviewer jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Rn Medical Reviewer jobs in Puerto Rico look for?

The top searched job categories for Rn Medical Reviewer jobs in Puerto Rico are:

What cities in Puerto Rico are hiring for Rn Medical Reviewer jobs?

Cities in Puerto Rico with the most Rn Medical Reviewer job openings:

Full-time

Re-posted 23 days ago


Job description

JOB SUMMARY:

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 OASIS documentation submitted by field clinicians to ensure accuracy, completeness, and regulatory compliance. Your expertise will directly support our mission of delivering high-quality, patient-centered care while optimizing clinical outcomes and reimbursement in alignment with Medicare and Medicaid guidelines.

PRIMARY RESPONSIBILITIES:

  • Review and validate OASIS assessments for accuracy, consistency, and completeness.
  • Ensure documentation aligns with CMS regulations and Revival’s internal standards.
  • Collaborate with field clinicians to clarify or correct OASIS documentation as needed.
  • Provide constructive feedback and education to staff on best practices for OASIS documentation.
  • Identify trends, documentation issues, and compliance risks; contribute to quality improvement initiatives.
  • Ensure timely and compliant submission of OASIS data to support accurate billing and clinical integrity.
  • Stay current with CMS guidelines, and OASIS requirements to ensure documentation excellence.

QUALIFICATIONS:

  • Graduate of an accredited School of Nursing.
  • Active and unrestricted Registered Nurse (RN) license.
  • Minimum 1 year of clinical nursing experience required
  • OASIS review experience preferred
  • Homecare experience preferred
  • Proficiency with EMR systems commonly used in home health care is a plus.
  • Exceptional attention to detail and analytical thinking.
  • Excellent written and verbal communication skills with a collaborative, team-focused approach.

Physical Requirements:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

List the different physical requirement(s) for this job

The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.