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Rn Nurse Reviewer Jobs (NOW HIRING)

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 ...

Zelis

Clinical Nurse Reviewer

Plano, TX · 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 ...

Zelis

Clinical Nurse Reviewer

Saint Louis, MO · 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

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 ...

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 ...

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

Plano, TX · On-site

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 Petersburg, FL · On-site

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 · On-site

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

Boston, MA · On-site

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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$37

$42

How much do rn nurse reviewer jobs pay per hour?

As of Aug 21, 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 (Registered Nurse) - Remote

Gainwell Technologies

Remote

$78K - $88K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 2 days ago

New

Gainwell Technologies rating

7.8

Company rating: 7.8 out of 10

Based on 82 frontline employees who took The Breakroom Quiz

138th of 245 rated software companies

Job description

Nurse Reviewer (Registered Nurse) - Remote

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary: We are seeking a Nurse Reviewer (RN) who will be responsible for performing clinical reviews to determine whether medical record documentation supports the need for services based on clinical criteria, coverage policies, and utilization and practice guidelines. This role involves accessing proprietary systems to review medical records, accurately documenting findings, and providing policy and regulatory support for review determinations.

Your role in our mission: Reviews and interprets medical records to determine medical necessity and appropriateness of care while meeting quality and productivity standards. Documents review decisions and supporting rationale accurately and timely. Determines approvals or refers cases to physician consultants and processes consultant decisions. Performs prior authorization, precertification, and retrospective reviews; prepares decision letters as needed. Assists with training, mentoring, and supporting new Nurse Reviewers. Maintains RN licensure and knowledge of clinical criteria, policies, and regulations. Cross-trains on multiple claim types to support business needs. Recommends process improvements and technology solutions to enhance quality, productivity, and client satisfaction.

What we're looking for: Proficiency in computer and typing skills, including Microsoft Windows, Outlook, Excel, Word, PowerPoint, and internet browsers. Active, unrestricted RN license in the United States and primary state of residence, along with an active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). Minimum of 5+ years of clinical experience in an inpatient hospital setting. Minimum of 2+ years of utilization review or claims auditing experience. Experience using Milliman or InterQual criteria. Ability to work standard business hours, collaborate effectively with cross-functional teams and departments, and maintain the flexibility to work extended hours as needed to support business demands.

What you should expect in this role: Full-time position. Day-one eligibility for medical, dental, vision, and paid time off benefits. Monday through Friday work schedule. Remote role available to employees residing within the United States. Travel requirement: 0-10%. The pay range for this position is $78,000.00 - $88,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

What Gainwell Technologies employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Gainwell Technologies logo

About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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