Medical Review Specialist, RN

MedWatch, LLC

Medical Review Specialist conducting utilization reviews for MedWatch. Responsible for ensuring medical necessity and compliance in hospital admissions and outpatient procedures.

Posted 6/24/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $64,000 - $68,000 per yearWebsite

About the role

Key responsibilities & impact

Conduct the Utilization Review process by obtaining medical information and confirming the medical necessity of hospital admissions and/or outpatient procedures
Identify her/himself by first name, title, and organization name when a call is made to or received from a facility, provider, or patient
Perform preadmission review for medical necessity of hospitalization and surgery
Assign diary date for review of continued hospital stay
Perform review for necessity of Second Surgical Opinions
Precert physical therapy for medical necessity
Perform review of medical necessity for designated outpatient tests and durable medical equipment
Perform initial and concurrent reviews during hospital stays
Notify claims office and re-insurer
Conduct phone inquiries to hospital/physician personnel regarding patient continued stay treatment and discharge status

Requirements

What you’ll need

Associate's degree in nursing, bachelor's preferred
Registered Nurse (current unrestricted, in state of practice)
Minimum 5 years varied clinical nursing experience
Good organizational skills and time management
Excellent verbal and written communication skills
Ability to handle difficult situations tactfully and diplomatically
Effective problem-solving and decision-making skills
Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint)

Benefits

Comp & perks

Paid time off
Medical insurance
Dental insurance
Vision insurance
Short and long-term disability
Life insurance
AD&D
401k with match
Critical illness coverage
Legal plan
Identity theft coverage
Pet insurance
Discount programs

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Utilization Reviewmedical necessity assessmentpreadmission reviewSecond Surgical Opinions reviewphysical therapy precertificationoutpatient tests reviewdurable medical equipment reviewinitial reviewsconcurrent reviews

Soft Skills

organizational skillstime managementverbal communicationwritten communicationtactfulnessdiplomacyproblem-solvingdecision-making

Certifications

Associate's degree in nursingBachelor's degree in nursingRegistered Nurse