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Rn Nurse Reviewer Jobs (NOW HIRING)

Dane Street, LLC

Registered Nurse Reviewer

Dane Street has embarked on a program where we are looking for Registered Nurses to perform reviews and clinical summaries for disability claims. The expected report turnaround time for the reviewer ...

Cohere Health

Lead RN Reviewer

$35 - $37/hr

Lead RN Reviewer Cohere's Service Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The Lead RN Reviewer in ...

Zelis

Clinical Nurse Reviewer

Boston, MA · 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 ...

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

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

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 ...

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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 25, 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

Registered Nurse Reviewer

Remote

Dane Street, LLC
51 - 200 employees
Learn more about Dane Street, LLCexternal

Contractor

Posted 6 days ago

Job description

Dane Street has embarked on a program where we are looking for Registered Nurses to perform reviews and clinical summaries for disability claims. The expected report turnaround time for the reviewer is 2 days. Initial training will be scheduled. The training will include a walkthrough of the Dane Street portal to ensure you are comfortable with the technology and to become familiar with the required formatting of the reports. Training material will also be shared (i.e. sample reports and client specific training documents). Following your training, you will have a Dane Street contact to assist you with any questions or concerns you have while completing reports. Please note this is an ongoing project-based need.
Job Summary
A clinical summary of the relevant medical documentation for the period under review. Based on client requirements, this could include:
  • A summary of each document (should include an author, date, and title, or type of document)
  • The claimant's impairing diagnosis
  • Any comorbid conditions that are impacting function and or recovery in the assessment.
  • Any relevant diagnostic testing, lab work, exam findings or other clinical information that is relevant to the impairing condition

A conclusion to the assessment. Based on client requirements, this section could include:
  • Restrictions and limitations that are specific to the condition for which the person is out of work
  • A duration for restrictions and limitations that are easily understood and supported based on the medical on file.
  • A rationale that is clinically based and supports the nurse reviewer's conclusions.
  • Answers to all referral questions posed.

Based on client requirements there may be calls required to the treating providers
Documentation should be written in a professional and concise manner
  • Free of clinical and/or claim acronyms, clinical titles are appropriate (MD, Dr, APRN)
  • Free of grammar and spelling issues
  • All medical terminology needs to be explained in layman's terms.
  • Written in a manner easily understood by the layperson avoiding unapproved abbreviations/acronyms that may not be easily understood by the non-medical professional.

Job Experience
  • Active Registered Nurse
  • Prior work experience in commercial disability insurance: disability insurance carrier or TPA (i.e., UNUM, Sedgwick, Mutual of Omaha)
  • Diverse Clinical Background

PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.
ABOUT DANE STREET (www.danestreet.com):
A fast-paced, Inc. 500 Company with a high-performance culture, Dane Street is seeking insightful, astute forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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