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Clinical Review Nurse Remote Jobs (NOW HIRING)

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Pharmacy Careers

Remote Clinical Review Pharmacist

$121K - $144K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

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Clinical Review Nurse Remote information

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$44

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How much do clinical review nurse remote jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for clinical review nurse remote in the United States is $44.13, according to ZipRecruiter salary data. Most workers in this role earn between $36.30 and $52.40 per hour, depending on experience, location, and employer.

What is a clinical review nurse remote?

Clinical Review Nurses working remotely are registered nurses who assess and review medical records, treatment plans, or insurance claims from a virtual location. Their primary responsibility is to ensure that patient care meets established guidelines and that services are medically necessary and appropriately documented. They often collaborate with healthcare providers, insurance companies, or government programs to provide clinical expertise and support decision-making processes. Remote positions allow these nurses to perform their duties from home or another offsite location, using secure digital platforms. This role typically requires strong analytical skills, attention to detail, and up-to-date nursing credentials.

How does a clinical review nurse remote typically collaborate with physicians and other healthcare professionals?

As a remote Clinical Review Nurse, collaboration with physicians and other healthcare professionals is primarily conducted through secure digital platforms, phone calls, and video conferencing. Nurses in this role review patient records, assess medical necessity, and communicate their findings or recommendations directly to providers, case managers, and insurance representatives. Building strong virtual communication skills is essential, as much of the teamwork relies on clear, concise documentation and timely follow-ups to ensure quality patient care and compliance with medical guidelines.

What are the key skills and qualifications needed to thrive as a clinical review nurse remote?

A Clinical Review Nurse Remote needs a current RN license, strong clinical expertise, and experience in case review or utilization management. Familiarity with electronic medical records (EMRs), review platforms, and payer-specific guidelines, often supported by certifications like CCM or URAC, is essential. Excellent analytical skills, attention to detail, and strong written communication set outstanding candidates apart in this role. These skills ensure accurate clinical evaluations, effective remote collaboration, and compliance with regulatory standards in healthcare delivery.

What is the difference between Clinical Review Nurse Remote vs Clinical Case Manager?

AspectClinical Review Nurse RemoteClinical Case Manager
CredentialsRN license, clinical review certification (e.g., CCRC)RN license, case management certification (e.g., CCM)
Work EnvironmentRemote, healthcare or insurance companiesRemote or in-office, healthcare or insurance settings
Industry UsageInsurance, healthcare, utilization reviewHealthcare, insurance, patient advocacy
Job FocusReview medical records for appropriateness of careCoordinate patient care and services

Both roles require nursing credentials and often involve remote work within healthcare or insurance industries. Clinical Review Nurses focus on evaluating medical records for care appropriateness, while Clinical Case Managers coordinate patient services and care plans. The roles are similar in environment and industry but differ in daily responsibilities.

How to become a clinical review nurse remote?

To become a remote clinical review nurse, candidates typically need a registered nurse (RN) license, relevant clinical experience, and knowledge of medical coding and documentation. Many roles require familiarity with electronic health records (EHR) systems and certification in case management or utilization review. Strong communication skills and the ability to work independently are also important for remote positions.

What does a remote clinical review nurse do?

A remote clinical review nurse evaluates patient records, medical histories, and treatment plans to determine appropriate care and insurance coverage. They analyze clinical data, ensure compliance with healthcare regulations, and communicate findings to healthcare providers or insurance companies, often using electronic health record systems. Strong clinical knowledge, attention to detail, and remote communication skills are essential for this role.
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Clinical Review Nurse Remote jobs near you
Infographic showing various Clinical Review Nurse Remote job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $91,797 per year, or $44.1 per hour.

Senior Clinical Review Nurse - Prior Authorization

Centene Corporation

Remote

$30.58 - $55.09/hr

Other

Medical, Retirement, PTO

Posted 3 days ago

New

Centene rating

8.4

Company rating: 8.4 out of 10

Based on 404 frontline employees who took The Breakroom Quiz

14th of 891 rated healthcare providers

Job description

Clinical Professional

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

This position requires NY State Licensure as a RN, OT or PT

Position Purpose: Routinely reviews more challenging prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Assesses more complex authorization requests and provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.

  • Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
  • Collaborates with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
  • Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
  • Manages service authorization requests for a member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities
  • Provides feedback on opportunities to improve the authorization review process for members
  • Manages as appropriate with healthcare providers, utilization management team, and care management team to assess medical necessity of care
  • Partners with interdepartmental teams on projects within utilization management as part of the clinical review team
  • Manages and reviews all member's clinical information in health management systems to ensure compliance with regulatory guidelines
  • Provides education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members
  • Develops in-depth knowledge of the prior authorization process and acts as a trainer to other team members
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 4 – 6 years of related experience. Advanced clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Strong knowledge of Medicare and Medicaid regulations preferred. Strong knowledge of utilization management processes preferred.

  • For Fidelis Plan Only: A clinical degree as a healthcare professional is required along with the appropriate license. Examples include Nursing, PT and OT. required

Pay Range: $30.58 - $55.09 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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