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Director Remote Utilization Review Jobs (NOW HIRING)

The Recovery Village

Utilization Review Specialist

$50K/yr

We are looking for a Remote Utilization Review Specialist Advanced Recovery Systems is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse ...

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

This role coordinates with Clinical Managers and Directors, Physicians, Business Office, and ... This position is posted as remote; however, per company policy, candidates residing within a ...

New

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Village Care

Utilization Review Nurse

Manhattan, NY · Remote

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - N ... Frequently collaborates and communicates with physician peer reviewers and medical directors in ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

Managed Staffing

Medical Director/Medical Officer

RI · Remote

$130 - $135/hr

Medical Director (Remote - USA) 100% Remote | Must have an active, unrestricted state medical ... This is a fully remote role supporting clinical teams, utilization review, and healthcare program ...

Medica

Utilization Review III

$70.20K - $120.40K/yr

Collaborate with Medical Directors for cases requiring physician review and support case ... This position is a Remote role. To be eligible for consideration, candidates must have a primary ...

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How much do director remote utilization review jobs pay per hour?

As of May 30, 2026, the average hourly pay for director remote utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Director of Remote Utilization Review, and why are they important?

To thrive as a Director of Remote Utilization Review, you need in-depth knowledge of healthcare regulations, utilization management processes, and a relevant clinical background, typically supported by an RN or other clinical licensure and experience in case management. Familiarity with utilization review software, electronic health records (EHR), and certifications such as CCM or UM are often required. Leadership, analytical thinking, and strong communication skills are vital for guiding teams and collaborating with stakeholders. These skills ensure effective oversight of remote teams, regulatory compliance, and optimal patient care outcomes.

How does a Director of Remote Utilization Review typically collaborate with clinical and administrative teams to ensure effective patient care management?

A Director of Remote Utilization Review plays a pivotal role in bridging clinical staff, case managers, and administrative teams to optimize patient care and resource utilization. This is often achieved through regular virtual meetings, data sharing, and cross-departmental strategy sessions to review utilization trends and address barriers to care. The director ensures that remote teams adhere to regulatory standards and organizational goals, fostering open communication to streamline workflows and resolve complex cases efficiently. Successful collaboration enhances patient outcomes, reduces unnecessary costs, and maintains compliance, all while supporting a positive remote team environment.

What is a Director of Remote Utilization Review?

A Director of Remote Utilization Review is a healthcare leader responsible for overseeing teams that assess the necessity, appropriateness, and efficiency of medical services, typically from a remote or virtual environment. This role ensures compliance with regulatory guidelines, optimizes resource use, and helps manage healthcare costs while maintaining quality patient care. Directors collaborate with physicians, nurses, and insurance providers to review clinical cases and develop utilization review strategies. They also monitor performance metrics and implement process improvements for remote teams.

What is the difference between Director Remote Utilization Review vs Utilization Review Nurse?

AspectDirector Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, advanced degree, and management experienceRegistered Nurse (RN) license, relevant clinical experience
Work EnvironmentOversees teams remotely, strategic planning, policy developmentConducts patient reviews, collaborates with healthcare providers, often remote or onsite
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare facilities

The main difference is that the Director Remote Utilization Review focuses on managing teams and policies remotely, while the Utilization Review Nurse performs clinical reviews directly related to patient care. The director has a broader strategic role, whereas the nurse role is more clinical and operational.

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Director Remote Utilization Review jobs near you

Remote Utilization Review RN - RURR 26-06086

NavitasPartners

Healdsburg, CA • Remote

$40 - $45/hr

Other

Posted 5 days ago

Job description

Job Title: Remote Utilization Review RN

Location: Santa Rosa, CA
Assignment Duration: 13 Weeks
Schedule: Day Shift - 5x8 Hours (8:00 AM - 4:30 PM)

Compensation:
  • Pay Rate: $40-$45/hr based on experience
Position Overview:

We are seeking an experienced Remote Utilization Review Registered Nurse (RN) to support healthcare operations by ensuring the appropriate use of medical services and resources. The ideal candidate will have strong knowledge of medical necessity criteria, payer guidelines, and utilization review processes while working collaboratively with interdisciplinary healthcare teams.

Responsibilities:
  • Perform utilization review activities to ensure appropriate and cost-effective use of healthcare resources
  • Review patient medical records for medical necessity and compliance with payer requirements
  • Collaborate with physicians, case managers, and interdisciplinary healthcare teams
  • Submit, track, and monitor authorizations, approvals, and denials
  • Maintain accurate, timely, and compliant documentation
  • Ensure adherence to healthcare regulations and payer guidelines
  • Communicate effectively with providers and healthcare staff regarding review outcomes
  • Support quality improvement initiatives related to utilization management
Qualifications:
  • Active Registered Nurse (RN) License
  • Recent Utilization Review experience preferred
  • Strong understanding of payer guidelines and medical necessity criteria
  • Excellent communication, critical thinking, and organizational skills
  • Ability to work independently in a remote environment
  • Strong documentation and computer skills
  • Ability to manage multiple tasks in a fast-paced healthcare setting

For more details reach at Aditi.sharma@navitashealth.com or Call / Text at 516-587-6677.

About Navitas Healthcare, LLC: It is a certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

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