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Cook Children's

UM/ECM - RN Reviewer HP

Fort Worth, TX · On-site

The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and ...

Verve LLC

Medical Nurse Reviewer

Baltimore, MD · On-site

The ideal candidate is a detail-oriented Registered Nurse with strong hospice, utilization review, and regulatory compliance experience. Responsibilities * Review hospice claims, clinical ...

Commence

IDR Nurse Reviewer

Virginia Beach, VA · On-site

The Nurse Reviewer position is responsible for supporting and conducting reviews and determinations ... Maintain an active license in nursing ( at a minimum, RN required) * Five years of full-time ...

Verisk

MSA Nurse Reviewer

Bradenton, FL · On-site

$80K - $88K/yr

... Nurse (RN) license in good standing with applicable Board of Nursing required • Experience in preparing medical review reports, medical bill reviews and utilization reviews in injury cases ...

Regal Medical Group

Reviewer, Clinical RN

Canoga Park, CA · On-site

$45 - $50/hr

Clinical Nurse Reviewer The Clinical Nurse Reviewer is focus on auditing the IP UM process and ... The pay range for this position at commencement of employment is expected to be between RN's $45 ...

Verisk

MSA Nurse Reviewer

Woburn, MA · On-site

$80K - $88K/yr

... Nurse (RN) license in good standing with applicable Board of Nursing required • Experience in preparing medical review reports, medical bill reviews and utilization reviews in injury cases ...

Verisk

MSA Nurse Reviewer

Bradenton, FL · On-site

... Nurse (RN) license in good standing with applicable Board of Nursing required Experience in ... review reports, medical bill reviews and utilization reviews in injury cases preferred ...

Verisk

MSA Nurse Reviewer

Woburn, MA · On-site

... Nurse (RN) license in good standing with applicable Board of Nursing required Experience in ... review reports, medical bill reviews and utilization reviews in injury cases preferred ...

Regal Medical Group, Inc.

$45 - $50/hr

The Clinical Nurse Reviewer is focus on auditing the IP UM process and identifying process ... The pay range for this position at commencement of employment is expected to be between RN's $45 ...

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How much do rn reviewer jobs pay per hour?

As of Jun 22, 2026, the average hourly pay for rn 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 the difference between Rn Reviewer vs Rn?

AspectRn ReviewerRn
CredentialsRegistered Nurse (RN) license, additional certification in medical review or quality assuranceRegistered Nurse (RN) license, standard nursing credentials
Work EnvironmentHealthcare facilities, insurance companies, or medical review organizationsHospitals, clinics, or healthcare settings
Job FocusReviewing medical records for insurance claims, compliance, or quality assuranceProviding direct patient care, nursing duties
Industry UsageInsurance, healthcare quality, medical reviewHealthcare, hospital, clinical settings

The main difference between an Rn Reviewer and an Rn is that the Rn Reviewer specializes in reviewing medical records and insurance claims, often working in insurance or quality assurance roles. In contrast, an Rn provides direct patient care in healthcare settings. Both roles require an RN license, but the Rn Reviewer typically has additional certifications related to medical review or compliance.

How to become an RN chart reviewer?

To become an RN chart reviewer, registered nurses typically need a valid nursing license and experience in clinical settings. Additional skills in medical record documentation, attention to detail, and familiarity with electronic health record systems are important; some roles may require specialized training or certifications in medical record review or coding.

What are some common challenges Rn Reviewers face when evaluating clinical documentation, and how can they overcome them?

One common challenge Rn Reviewers encounter is ensuring accuracy and completeness in complex clinical documentation, which can vary widely between providers and healthcare settings. Navigating inconsistent or incomplete records requires strong attention to detail and effective communication with clinical staff to clarify ambiguities. Overcoming these challenges often involves staying updated on best practices, leveraging electronic health record (EHR) tools, and collaborating closely with interdisciplinary teams to ensure all relevant information is accurately captured and compliant with regulatory standards.

What is an RN reviewer?

An RN reviewer is a registered nurse responsible for evaluating medical records, documentation, and clinical information to ensure accuracy, compliance, and quality standards. They often work in healthcare quality assurance, insurance, or legal settings, using their nursing expertise to assess patient care documentation and support decision-making processes.

How to make an extra $1000 a month as a nurse?

Rn reviewers can increase their income by taking on per diem or agency nursing shifts, which often pay higher rates, or by offering specialized services such as telehealth consultations if they have relevant certifications. Developing additional skills or certifications in high-demand areas can also open opportunities for higher-paying side work or consulting roles.

What are RN Reviewers?

RN Reviewers are registered nurses who evaluate medical records, clinical documentation, and healthcare cases to ensure accuracy, compliance, and quality of care. They often work for insurance companies, hospitals, or healthcare organizations, reviewing patient charts to determine if services meet established guidelines. RN Reviewers play a critical role in utilization management, case review, and quality assurance processes. Their work helps ensure that patients receive appropriate care and that healthcare providers adhere to best practices and regulatory requirements.

How to make 300,000 a year as a nurse?

To earn $300,000 annually as an RN, nurses often pursue specialized roles such as nurse anesthetist, nurse practitioner, or clinical nurse specialist, which require advanced certifications and education like a master's or doctoral degree. Gaining extensive experience, working in high-demand settings, and sometimes taking on overtime or travel assignments can also increase income potential.

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

To thrive as an RN Reviewer, you need a current registered nurse license, strong clinical judgment, and experience in case review or utilization management. Familiarity with medical review software, electronic health records (EHRs), and knowledge of regulatory standards like CMS guidelines is typically required. Excellent analytical skills, attention to detail, and effective written and verbal communication help you stand out in this role. These competencies ensure accurate case evaluations, regulatory compliance, and effective collaboration with healthcare teams.
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Rn Reviewer jobs near you
UM/ECM - RN Reviewer HP

UM/ECM - RN Reviewer HP

Cook Children's

Fort Worth, TX • On-site

Full-time

Posted 18 days ago

Cook Children's Health Care System rating

7.7

Company rating: 7.7 out of 10

Based on 73 frontline employees who took The Breakroom Quiz

162nd of 875 rated healthcare providers

Job description

Location:

Calmont Operations Building

Department:

Utilization

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP.

Additional Information:

Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP.
Education/Education:

  • Associate degree of Nursing required, BSN preferred.

  • Minimum of five (5) years clinical experience.

  • 2 years utilization management or case management experience required.

Strong skills in the following areas: Oral and written communication; Critical thinking; Organization and time management; Customer service.


Certification/Licensure:

  • Current unrestricted Registered Nurse licensure in the State of Texas.

About Us:

Cook Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

Cook Children's is an equal opportunity employer. As such, Cook Children's offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

What Cook Children's Health Care System employees say

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About Cook Children's Health Care System

Sourced by ZipRecruiter

Cook Children's Health Care System, based in Fort Worth, Texas, operates in the healthcare industry with a primary focus on pediatric health services. Established in 1918, the system has been committed to improving the health of children through the prevention and treatment of childhood diseases. This integrated pediatric healthcare system includes a medical center, physician network, home health company, research institute, and a health plan. At the core of its operations is the mission to 'Improve the Health of Every Child' in its community, reflecting its commitment to providing quality care, research, education, and prevention and wellness services.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Fort Worth, TX, US

Year founded

1918

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