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Rn Nurse Reviewer Jobs (NOW HIRING)

Lead RN Reviewer

$35 - $37/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

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 ...

Nurse Reviewer 1

Grand Prairie, TX · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Nurse Reviewer, RN

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

As a Nurse Reviewer at BCBSWY, you will be part of an amazing team of knowledgeable professionals ... An active, unrestricted Registered Nurse license for the state of Wyoming is required. BCBSWY ...

Nurse Reviewer 1

Wilmington, DE · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Nurse Reviewer 1

Atlanta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Nurse Reviewer 1

Miami, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Clinical Nurse Reviewer

Saint Louis, MO · On-site

$59K - $75K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

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 ...

Nurse Reviewer 1

Mason, OH · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Nurse Reviewer 1

Miami, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

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 ...

Clinical Nurse Reviewer

Saint Petersburg, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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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Showing results 1-20

Rn Nurse Reviewer information

See salary details

$28

$37

$42

How much do rn nurse reviewer jobs pay per hour?

As of Aug 15, 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 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 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 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.

How to become a registered nurse reviewer?

To become a registered nurse reviewer, you typically need to hold an active RN license, gain clinical nursing experience, and develop strong analytical and communication skills. Some positions may require familiarity with medical record review, healthcare regulations, or certification in case review or utilization management. Continuing education or specialized training in medical review processes can also enhance eligibility.

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.

More about Rn Nurse Reviewer jobs

What cities are hiring for Rn Nurse Reviewer jobs?

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What states have the most Rn Nurse Reviewer jobs?

States with the most job openings for Rn Nurse Reviewer jobs include:

$35 - $37/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago


Job description

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 Service Operations position is a crucial role in our organization. In this role, you are responsible for coaching, mentoring, evaluating and developing the RN team. The Lead RN Reviewer will use established operational tools to ensure all RN staff are meeting or exceeding performance metrics and quality standards established by the leadership team.

As a Lead RN Reviewer, you will work closely with the leadership team and report to the Clinical Supervisor of Service Operations. You will be responsible for providing supervision for the RN Reviewers to meet or exceed operational objectives and metrics. You will leverage both your creative skills and communication skills to promote a high performing clinical team. At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunities.

What you'll do:

  • Gain a deep understanding of Cohere's product and our health plan partners
  • Provide general supervision over the nursing staff. This includes interviewing new hires, training, coaching, mentoring, quality auditing and oversight of quality improvement plans initiated by the Clinical Supervisor and or Director.
  • Coordinates and provides day-to-day oversight and direction to clinicians
  • Assist in addressing any case escalations or provider issues
  • Other duties as assigned

What you'll need:

  • 5+ years in healthcare, managed care, or insurance-related roles
  • 1–2 years in a lead or supervisory capacity, with experience coaching or training others
  • A current, active RN license (BSN preferred)
  • Utilization Management experience required
  • Comfort interpreting operational data and metrics to identify process improvements
  • Excellent communication, collaboration, and organizational skills
  • A kind, patient, and flexible leadership style suited for a remote, fast-paced environment

Pay & Perks:

Fully remote opportunity with about 5% travel

Medical, dental, vision, life, disability insurance, and Employee Assistance Program

401K retirement plan with company match; flexible spending and health savings account

Up to 184 hours (23 days) of PTO per year + company holidays

Up to 14 weeks of paid parental leave

Pet insurance

The salary range for this position is $35 to $37 hourly; as part of a total benefits package which includes health insurance, 401k and bonus. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

Interview Process*:

  1. Connect with Talent Acquisition for a Preliminary Phone Screening
  2. Internet Speed Test Take Home Assignment
  3. Meet your Hiring Manager!

*Subject to change

About Cohere Health:

Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

With the acquisition of ZignaAI, we've further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validateâ„¢, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

Cohere Health's innovations continue to receive industry wide recognition. We've been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.

The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

Equal Opportunity Statement:

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it's personal.