Medical Review Nurse Jobs in the United States
Lumen Solutions Group, Inc.
Baltimore, MD
We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.
Incredible Health
$59030 - $77630
Macon, GA
Employer features: Academic medical center, Adoption Assistance, Best Places to Work recognition, Career Advance Program, Community hospital, Disability Insurance, Family Care Benefits, FSA, Health Insurance, Level 1 trauma center, Level 2 trauma center, Level 4 trauma center, Life Insurance, Magnet recognized, Medical, Offers sign on bonus, PTO, Retirement Plan, Teaching Hospital, Tuition Assistance, U.S. News best hospital . Hospitals on Incredible Health are actively hiring and accepting applications in the Macon, GA area for the following position: Registered Nurse - Utilization Review.
Providence Health and Services
$43.29 - $76.06
Jber, AK
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, outreach programs, and hospice and home care. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Williamson Health
Murfreesboro, TN
The flagship facility, Williamson Medical Center, which recently opened its new Boyer-Bryan West Tower, offers extensive women's services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Timely reviews patients within 24 hours or next business day after admission and at a minimum of every 2 days thereafter for continued stay, applying appropriate criteria (Interqual®) and facilitating reimbursement for services with third payer parties, obtaining and entering authorization number/approval status and notes in Meditech.
Grand Strand Medical Center
Myrtle Beach, SC
We offer a range of services for our patients - including the only cardiac surgery program, neurosurgery program, pediatric intensive care unit, Level I trauma center with two free-standing emergency departments, advanced wound care center, breast cancer center and Carolina Forest Imaging Center. At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing.".
HCA Florida Fawcett Hospital
Port Charlotte, FL
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Educate patients, families, and caregivers about the patient's medical condition, treatment plan, medications, possible side effects, and follow-up measures, ensuring complete understanding by translating complex medical terminology.
CHRISTUS Health
Irving, TX
Outreach to TOC patients should focus on medication reconciliation/adherence, self-management, use of personal health records, follow-up with PCPs/Specialists, and review of indicators that a patient’s condition is worsening and how to respond. Promotes a positive work environment by displaying a caring, sensitive approach to others, as evidenced by listening, understanding, and responding to the needs of patients, colleagues, and supervisors.
Mission Hospital
Hickory, NC
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Mission Hospital, a member of Mission Health, an operating division of HCA Healthcare, located in Asheville, North Carolina, serves as the regional tertiary and quaternary care center in Western North Carolina and the adjoining region.
Kaiser Permanente
Wailuku, HI
Supports high-quality consultation by: communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care, under direct supervision; and leveraging working knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians. In addition to the responsibilities listed below, this position is also responsible for leveraging clinical knowledge of evidence-based guidelines, insurance policies, and clinical criteria to consult on the medical necessity, level of care, and duration of treatment required for basic reviews, and collaborating with the health care team, members, and caregivers to assist in discharge planning, cost of care options, and/or coordinating referrals to appropriate services based on medical necessity.
Providence Health and Services
$44.16 - $77.58
Eagle River, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
Mission Hospital
Brevard, NC
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Leapfrog Hospital Safety Grade recognized Mission Hospital with an "A," nationally recognizing Mission Hospital's achievements in protecting patients and providing safer healthcare.
HCA Florida Fawcett Hospital
Port Charlotte, FL
At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing.". Critical thinking, service excellence and good interpersonal communication skills, ability to read/comprehend written instructions, ability to follow verbal instructions, PC skills.
University of Kansas Health System
Kansas City, KS
Patient populations include, but are not limited to, diabetes, hypertension, heart failure, kidney failure, liver failure, respiratory failure, COPD, asthma, GI bleeds, electrolyte imbalances, sepsis, and conditions requiring telemetry observation. Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing Registered Nurse in State of Kansas or State of MissouriAs a condition of your employment and continued employment with the health system, you are required to secure a Nurse Compact License (NCL) within 60 days of your date of hire.
Providence Health and Services
$57.28 - $88.92
Mission Hills, CA
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence Health and Services
$57.28 - $88.92
Santa Clarita, CA
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Mission Hospital
Rutherfordton, NC
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Educate patients, families, and caregivers about the patient's medical condition, treatment plan, medications, possible side effects, and follow-up measures, ensuring complete understanding by translating complex medical terminology.
St. Luke's University Health Network
Allentown, PA
Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The RN DRG Downgrades Appeals Review Specialist is responsible for the retrospective clinical review and defense of inpatient DRG downgrades, clinical validation denials, and medical necessity determinations issued by governmental and commercial payers.
Valley Manor Care Center
$37.45 - $44.95
Eckert, CO
While providing care to our patients, we want our staff to feel cared for and love their work while maintaining a work-life balance, so offering employees paid-time off benefits is a part of our comprehensive benefits package Our diverse and involved staff members are supported by the commitment to maintain relationships of functional trust with every team member, to always practice solutions-focused problem solving, and to continually affirm each team member’s contribution to the quality of our work. Provides Leadership and Direction on Assigned UnitRole models positive communication skills with NA/R’s, C.N.A.’s, STNAs, TMA’s (if applicable), interdisciplinary team, supervisory and management team, customers, residents and families.
Spalding Rehabilitation-Part of Presbyterian St.Luke's Rehab
$36.5 - $53.25
Denver, CO
HCA Healthcare Co-FounderSince 1968, Spalding Rehabilitation Hospital has been in the business of rebuilding lives and renewing hope by offering intensive inpatient and outpatient rehabilitation programs, tailored specifically to patients needs. As part of our mission to help individuals achieve maximum independence, the hospital works closely with the Brain Injury Alliance of Colorado and is also an active supporter of the Rocky Mountain Stroke Association, serving stroke patients and their families.
Del Sol Medical Center
Socorro, TX
As a majority owner of Galen College of Nursing, which joins Research College of Nursing and Mercy School of Nursing as educational facilities within the HCA Healthcare family, we make it easier and more affordable to gain certifications and job skills. Collaborating with medical providers and the care team, you will provide personalized, comprehensive, and compassionate care, following established nursing models such as "Assess, Perform, Teach, and Manage."
Wesley Woodlawn Hospital & ER
Wichita, KS
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. From door side parking to a convenient one-story campus where state-of-the-art treatments and technologies are always only a few steps away, Wesley Woodlawn Hospital & ER delivers more than you might expect from a community hospital in Wichita, Kansas.
Parkland Medical Center
Strafford, NH
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Educate patients, families, and caregivers about the patient's medical condition, treatment plan, medications, possible side effects, and follow-up measures, ensuring complete understanding by translating complex medical terminology.
HCA HealthONE Presbyterian St. Luke's
$40.15 - $58.58
Denver, CO
Offering services across the continuum of care to meet patients’ total healthcare needs, HCA HealthONE includes seven acute care hospitals, a dedicated flagship pediatric hospital, a rehabilitation hospital, CareNow® urgent care clinics, mental health campuses, imaging and surgery centers, physician practices, home and hospice care, and AirLife Denver, which provides regional critical care air and ground transportation. Consistently among the Denver Business Journals’ list of top corporate philanthropists in the Denver-metro area, HCA HealthONE was named as one of the most community-minded organizations by The Civic 50 and contributed more than $1 million through cash and in-kind donations last year alone, along with more than $400M in federal, state and local taxes.
HCA HealthONE Swedish
$36.5 - $53.25
Englewood, CO
Offering services across the continuum of care to meet patients’ total healthcare needs, HCA HealthONE includes seven acute care hospitals, a dedicated flagship pediatric hospital, a rehabilitation hospital, CareNow® urgent care clinics, mental health campuses, imaging and surgery centers, physician practices, home and hospice care, and AirLife Denver, which provides regional critical care air and ground transportation. Consistently among the Denver Business Journals’ list of top corporate philanthropists in the Denver-metro area, HCA HealthONE was named as one of the most community-minded organizations by The Civic 50 and contributed more than $1 million through cash and in-kind donations last year alone, along with more than $400M in federal, state and local taxes.
Parkland Medical Center
Strafford, NH
As part of HCA Healthcare’s trusted network, you’ll be connected toCatholic Medical Centerin Manchester, Portsmouth Regional Hospitalin Portsmouth,Frisbie Memorial Hospitalin Rochester, three freestanding ERs, and more than 70 care sites across New Hampshire. With nearly 5,000 colleagues—including 1,500 nurses and 1,000 affiliated physicians—HCA Healthcare offers a supportive, team-oriented environment where your contributions are valued, your growth is encouraged, and your impact is felt every day.
HCA Florida North Florida Hospital
Gainesville, FL
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Educate patients, families, and caregivers about the patient's medical condition, treatment plan, medications, possible side effects, and follow-up measures, ensuring complete understanding by translating complex medical terminology.
HCA Florida North Florida Hospital
Gainesville, FL
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Collaborating with medical providers and the care team, you will provide personalized, comprehensive, and compassionate care, following established nursing models such as "Assess, Perform, Teach, and Manage."
HCA Healthcare Trident Hospital
Florence, SC
Trident Health is a 445-bed HCA Healthcare hospital system comprised of two acute care hospitals, Trident Medical Center and Summerville Medical Center and three freestanding emergency departments, Brighton Park Emergency, Moncks Corner Medical Center and Centre Pointe Emergency. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
Reston Hospital Center
Reston, VA
At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing.". As a Registered Nurse Medical Surgical, your voice to influence patient care is valued and empowered at every turn –whether through open, collaborative relationships with your direct manager or more formal opportunities through hospital councils and national nursing initiatives.
St. David's South Austin Medical Center
Round Rock, TX
Key programs include a nationally accredited oncology program featuring the region’s only adult Transplant and Cellular Therapy Program; a Level II trauma center; advanced cardiac, stroke, and orthopedic services; full‑service maternity and newborn care; and four community emergency centers in Bee Cave and Bastrop. The facility is affiliated with theTexas Institute for Robotic Surgery, providing advanced robotic capabilities for orthopedics, open heart and lung procedures, complex GI surgery, surgical oncology, general and colorectal surgery, and urology.
Methodist Health System
Richardson, TX
We also provide services at Methodist Richardson Medical Center – Campus for Continuing Care, which include a behavioral health and addiction recovery unit, inpatient rehabilitation, long-term acute care, and more. Methodist Richardson Medical Center is a 443-bed, full-service, acute care hospital that serves Richardson, Garland, Plano, and surrounding areas in Dallas and Collin counties.
HCA HealthONE Spalding Rehabilitation
$36.5 - $53.25
Aurora, CO
Offering services across the continuum of care to meet patients' total healthcare needs, HCA HealthONE includes seven acute care hospitals, a dedicated flagship pediatric hospital, a rehabilitation hospital, CareNow® urgent care clinics, mental health campuses, imaging and surgery centers, physician practices, home and hospice care, and AirLife Denver, which provides regional critical care air and ground transportation. Consistently among the Denver Business Journals' list of top corporate philanthropists in the Denver-metro area, HCA HealthONE was named as one of the most community-minded organizations by The Civic 50 and contributed more than $1 million through cash and in-kind donations last year alone, along with more than $400M in federal, state and local taxes.
UCHealth
$35.29 - $54.71
Loveland, CO
Employees have access to free assistance navigating the Public Service Loan Forgiveness program and submitting their federal student loans for forgiveness. Performance bonus: UCHealth offers a 3-Year Incentive Bonus to recognize employee contributions to our success in quality, patient experience, organizational growth, financial goals and tenure.
St. David's Round Rock Medical Center
Round Rock, TX
As a majority owner of Galen College of Nursing, which joins Research College of Nursing and Mercy School of Nursing as educational facilities within the HCA Healthcare family, we make it easier and more affordable to gain certifications and job skills. This comprehensive medical center features the only hybrid operating room in the county, a 24-hour emergency department with a Level II trauma center, and leading-edge cardiac care through the Heart Hospital of Austin at St. David’s Round Rock.
Las Palmas Medical Center
Sunland Park, NM
As a majority owner of Galen College of Nursing, which joins Research College of Nursing and Mercy School of Nursing as educational facilities within the HCA Healthcare family, we make it easier and more affordable to gain certifications and job skills. Educate patients, families, and caregivers about the patient's medical condition, treatment plan, medications, possible side effects, and follow-up measures, ensuring complete understanding by translating complex medical terminology.
St. David's Round Rock Medical Center
Round Rock, TX
This comprehensive medical center features the only hybrid operating room in the county, a 24-hour emergency department with a Level II trauma center, and leading-edge cardiac care through the Heart Hospital of Austin at St. David’s Round Rock. In collaboration with medical providers and other members of the care team, the RN provides individualized, comprehensive, and compassionate care using established nursing models such as “Assess, Perform, Teach, and Manage.”
LewisGale Hospital Montgomery
Blacksburg, VA
At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing.". At HCA Healthcare, there are many ways for nurses to have a voice through professional practice councils, advisory councils, vital voices surveys, and units of distinction.
Spectraforce Technologies Inc
Atlanta, GA
Configuration support will be for both pharmacy and medical criteria and will require good creative problem solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency. Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers.
HCA HealthONE Presbyterian St. Luke's
$36.5 - $53.25
Denver, CO
Offering services across the continuum of care to meet patients’ total healthcare needs, HCA HealthONE includes seven acute care hospitals, a dedicated flagship pediatric hospital, a rehabilitation hospital, CareNow® urgent care clinics, mental health campuses, imaging and surgery centers, physician practices, home and hospice care, and AirLife Denver, which provides regional critical care air and ground transportation. Consistently among the Denver Business Journals’ list of top corporate philanthropists in the Denver-metro area, HCA HealthONE was named as one of the most community-minded organizations by The Civic 50 and contributed more than $1 million through cash and in-kind donations last year alone, along with more than $400M in federal, state and local taxes.
BoldAge PACE
Evansville, IN
Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen. . Provide coordination and direct care as indicated to promote continued care in the community or promote optimal institutional care (Assisted Living, Nursing Home, Hospital, etc.) as needed.
Las Palmas Medical Center
Sunland Park, NM
As a Registered Nurse Medical Surgical Oncology, your voice to influence patient care is valued and empowered at every turn –whether through open, collaborative relationships with your direct manager or more formal opportunities through hospital councils and national nursing initiatives. Under the general supervision of the Charge Nurse or Unit Director the staff nurse assumes responsibility for direct nursing care and coordination of care with ancillary units and physicians on his/her designated shifts.
Las Palmas Medical Center
Sunland Park, NM
As a Registered Nurse Medical Surgical, your voice to influence patient care is valued and empowered at every turn –whether through open, collaborative relationships with your direct manager or more formal opportunities through hospital councils and national nursing initiatives. At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing.".
Kinetic Personnel Group
Ontario, CA
Requirements: Three (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
HCA Florida Capital Hospital
Tallahassee, FL
Our facilities include a state-of-the-art Behavioral Health Center, Cancer Center, Chest Pain Center w/PCI-Resuscitation, Family Center, Heart & Vascular Center, Imaging Services, Neonatal Intensive Care Unit, Orthopedic/Spine Center, Physical Therapy Services, Rehabilitation Center, Stroke Center, Surgical Services, Surgical Weight Loss Center, Network-of-Care Affiliated Physician Practices, and much more. In collaboration with other members of the management team, the CNC directs, monitors, and evaluates nursing care in accordance with established policies/procedures, serves as a resource person for staff, and models a commitment to the organization’s vision/mission/values to support an unparalleled patient experience and clinical outcomes that contribute to overall departmental performance.
Memorial Health University Medical Center
Pooler, GA
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Educate patients, families, and caregivers about the patient's medical condition, treatment plan, medications, possible side effects, and follow-up measures, ensuring complete understanding by translating complex medical terminology.
Medical City Arlington
Arlington, TX
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Collaborating with medical providers and the care team, you will provide personalized, comprehensive, and compassionate care, following established nursing models such as "Assess, Perform, Teach, and Manage."
Memorial Satilla Health
Waycross, GA
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. This is a full-time, night shift position on our Med/Surg team that offers competitive compensation plus differentials, full benefits, sign-on bonus and relocation assistance and a huge opportunity for growth as you'll be joining the largest provider of healthcare services in the country.
Methodist Hospital Specialty and Transplant
San Antonio, TX
In addition to transplant care, Methodist Hospital Specialty and Transplant is a full service hospital with over 260 beds that provides specialized services for liver cancer care, emergency care, weight loss surgery, urology surgery, vascular surgery, inpatient rehabilitation, colorectal surgery and behavioral health care. According to the United Network of Organ Sharing database, the center reached a major milestone in 2019 by performing 231 living donor kidney transplants in a single year setting a new national record - that’s 65 more transplants than the second center on the list.
Novant Health
Thomasville, NC
If your RN nursing license has been inactive, retired or lapsed for five years or more and you have not been licensed in another state during the last five years, successful completion of a Board approved refresher course is required prior to reactivating or reinstating your license. By engaging the strengths and talents of each team member, we ensure a strong organization capable of providing remarkable healthcare to our patients, families and communities.