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Rn Nurse Reviewer Jobs (NOW HIRING)

Elevance Health

Nurse Reviewer 1

Mason, OH · On-site

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually ... Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and ...

Elevance Health

Nurse Reviewer 1

Wilmington, DE · On-site

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually ... Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and ...

Elevance Health

Nurse Reviewer 1

Tampa, FL · On-site

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually ... Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and ...

Elevance Health

Nurse Reviewer 1

Atlanta, GA · On-site

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the ... Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and ...

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 ...

Elevance Health

Nurse Reviewer 1

Miami, FL · On-site

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the ... Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and ...

Elevance Health

Nurse Reviewer 1

Wilmington, DE · On-site

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the ... Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and ...

Elevance Health

Nurse Reviewer 1

Mason, OH · On-site

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the ... Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and ...

Elevance Health

Nurse Reviewer 1

Atlanta, GA · On-site

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the ... Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and ...

Elevance Health

Nurse Reviewer 1

Grand Prairie, TX · On-site

Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the ... Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and ...

Zelis

Clinical Nurse Reviewer

Morristown, NJ

Conduct review of facility and outpatient bills as it compares with medical records and coverage ... Current/active RN License. * Typically has a BA or 3-5 years of experience. * Requires proficiency ...

Zelis

Clinical Nurse Reviewer

Saint Louis, MO

Conduct review of facility and outpatient bills as it compares with medical records and coverage ... Current/active RN License. * Typically has a BA or 3-5 years of experience. * Requires proficiency ...

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 ...

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Rn Nurse Reviewer information

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$28

$37

$42

How much do rn nurse reviewer jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for rn 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 an RN nurse reviewer?

RN Nurse Reviewers are registered nurses who evaluate medical records, treatment plans, and healthcare services for quality, compliance, and appropriateness. They often work for insurance companies, hospitals, or healthcare organizations to conduct utilization reviews, ensure adherence to clinical guidelines, and support decisions about healthcare coverage. Their work helps improve patient care, manage costs, and ensure that care meets regulatory and organizational standards.

What are some common challenges RN nurse reviewers face when transitioning from bedside nursing to a review role?

Many Rn Nurse Reviewers find the shift from direct patient care to a more analytical, documentation-based environment to be a significant adjustment. Instead of hands-on care, the role focuses on reviewing patient records, applying clinical guidelines, and ensuring compliance with regulatory standards, which requires strong attention to detail and critical thinking. Adapting to stricter productivity metrics, meeting tight deadlines, and collaborating with multidisciplinary teams across remote or office settings are also common challenges. However, the opportunity to positively impact patient outcomes through quality assurance and policy improvement can be very rewarding.

What are the key skills and qualifications needed to thrive as an RN nurse reviewer, and why are they important?

To excel as an RN Nurse Reviewer, you need a valid RN license, strong clinical knowledge, and experience in case management or utilization review. Familiarity with medical review software, electronic health records (EHRs), and regulatory guidelines like Medicare and Medicaid is typically required. Attention to detail, analytical thinking, and excellent written communication are essential soft skills for evaluating medical records and preparing clear reports. These skills ensure accurate assessments, compliance with healthcare standards, and support quality patient care decisions.

What is the difference between Rn Nurse Reviewer vs Medical Reviewer?

AspectRn Nurse ReviewerMedical Reviewer
CredentialsRegistered Nurse (RN) license, nursing certificationsMedical degree or nursing license, specialized medical certifications
Work EnvironmentHealthcare facilities, insurance companies, review organizationsHospitals, insurance companies, healthcare consulting firms
Employer & IndustryInsurance companies, healthcare agencies, legal firmsInsurance companies, healthcare organizations, legal firms
Primary FocusReviewing medical records from a nursing perspectiveAssessing medical records for accuracy and compliance from a clinical perspective

Both Rn Nurse Reviewers and Medical Reviewers evaluate medical records, but Rn Nurse Reviewers focus on nursing aspects and patient care, while Medical Reviewers have broader medical expertise. The roles often overlap in insurance and healthcare settings, with the main difference being the scope of medical knowledge applied.

How to become a registered nurse reviewer?

To become a registered nurse reviewer, you typically need to hold an active RN license, gain clinical experience in healthcare settings, and develop strong knowledge of medical documentation and review processes. Additional certifications in case management or healthcare quality assurance can enhance qualifications, and familiarity with electronic health records (EHR) systems is often required.
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Rn Nurse Reviewer jobs near you

Nurse Reviewer, RN

Blue Cross Blue Shield of Wyoming

Cheyenne, WY • On-site

Other

Posted 22 days ago

Job description

Nurse Reviewer

As a Nurse Reviewer at BCBSWY, you will be part of an amazing team of knowledgeable professionals working to ensure appropriate care is provided to our customers.

You will be accountable for reviewing claims and appeals to determine if necessary care has been provided. You'll apply medical policy and other requirements, using Interqual, discussions with medical providers and pharmacists, and other resources to ensure patients receive the highest quality care available within fair and equitable guidelines.

To succeed in this role, you will need to be able to apply critical thinking skills, work with a team of clinical and non-clinical staff, multi-task, and have flexibility in an ever-changing healthcare system.

An active, unrestricted Registered Nurse license for the state of Wyoming is required.

BCBSWY is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. Qualified applicants are provided with an equal opportunity and selection decisions are based on job-related factors.

We use E-Verify to confirm employment eligibility; we DO NOT sponsor applicants for work visas.

BCBSWY is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided reasonable accommodations for the application, selection, and hiring process. If reasonable accommodation is needed, please contact: HR@BCBSWY.com

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