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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 ...

Zelis

Clinical Nurse Reviewer

Atlanta, GA · On-site

$59K - $75K/yr

Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service, pre or post ... Current/active RN License. * Typically has a BA or 3-5 years of experience. * Requires proficiency ...

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

$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

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 ...

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 ...

Dane Street

PRN Utilization Review Nurse Reviewer

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring ... Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a ...

Zelis

Clinical Nurse Reviewer

Boston, MA

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

Atlanta, GA

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 ...

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Rn Nurse Reviewer information

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How much do rn nurse reviewer jobs pay per hour?

As of Aug 20, 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, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 24 days ago

Job description

Deep Roots. Solid Growth. Caring People.
Rooted in Wyoming! We are Blue Cross Blue Shield Wyoming: a not-for-profit health insurer with offices throughout the state. Ever since a small group of caring, persistent Wyoming women helped us put down roots in 1945, everything we do is aimed at better health care for the people of Wyoming.
Our Vision: We envision a future where integrity, compassion, and trust define a local health insurance experience. Committed to doing the right thing for our members, employees, and community, we strive to protect and contribute to the health and care of all we serve.
Our Mission: provide our members with access to local health insurance solutions that prioritize health, care, and well-being for those who call Wyoming home.
If our passion and purpose resonate with you, you may be who we are looking for. The role we are looking to fill:
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 Employees Enjoy:
Best-In-Class Health Insurance at minimal to no-cost for BCBSWY employees! PLUS many other benefits along with highly competitive compensation!
Our compensation program is reviewed for competitive market match on an annual basis and employees are eligible for annual merit increases. Monthly incentives that are based on individual and company performance are also available to eligible employees and members of our Sales Team can realize generous performance-based commissions.
At BCBSWY our employees are provided best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include medical, dental, vision, 401(k), life insurance, paid time off (PTO), 10 paid holidays in addition to PTO annually, plus 8 paid volunteer hours, various wellness programs, and a dress code of "Dress for Your Day!" which can mean jeans every day (depending on your role).
Serving Those Who Call Wyoming Home.
Our positions are all based in Wyoming. Depending on the department and the position, eligible employees may be offered limited In-Office/WFH flexibility (for those positions that are offered limited WFH, there will be a required number of In-Office days per week/month depending on department). Executive level employees are required to reside full-time in Wyoming.
Our Selection Process:
Typically includes the following (NOTE: process steps may differ depending on role applied for)
  • Review of your completed application and any additional submitted materials (e.g., cover letter, certifications, etc.) for minimum qualifications and skills alignment.
  • Confirmation of Wyoming residency, intent to become a Wyoming resident, or reasonable commuter distance if Colorado resident.
  • Recruiter Phone Screen.
  • Possible Self-Assessment and/or Questionnaire.
  • Initial interview with Hiring Manager.
  • Possible 2nd Interview with Hiring Manager and/or additional Team members.
  • Comprehensive Background Check.

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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