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Flex Schedule Remote Utilization Review Nurse Jobs

3B Healthcare, Inc.

RN - Utilization Review

Torrance, CA · Remote

Registered Nurse - Utilization Review (Remote)This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient ...

New

3B Healthcare, Inc.

RN - Utilization Review

Torrance, CA · Remote

Registered Nurse - Utilization Review (Remote)This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient ...

New

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

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 ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Netsmart

Utilization Review Nurse

Responsible for utilization review work for emergency admissions and continued stay reviews ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

McBee Associates

Utilization Review Nurse

Responsible for utilization review work for emergency admissions and continued stay reviews ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

KYYBA

Be Seen First

Remote Utilization Review RN

Detroit, MI · Remote

$35 - $39/hr

Utilization Review RN Contract Duration: 12+ months Job Location: 100% REMOTE License Requirements ... Coordinate training operations, including scheduling, class administration, new hire system access ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Ability to work independently in fast-paced environments SCHEDULE Monday through Friday - 8:00am ...

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How much do flex schedule remote utilization review nurse jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for flex schedule remote utilization review nurse 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.
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Flex Schedule Remote Utilization Review Nurse jobs near you
Infographic showing various Flex Schedule Remote Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 72% Full Time, 17% Part Time, and 11% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Remote UTILIZATION REVIEW NURSE - RN

Nexus Health Systems

Remote

Other

Medical, Dental, Vision, Retirement, PTO

Posted 7 days ago

Nexus Health Systems rating

6.3

Company rating: 6.3 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Remote Utilization Review Registered Nurse (UR RN)
Location: Remote (Texas RN License or Compact License Required)
Company: Nexus Health Systems
Employment Type: Full-Time
Make an Impact from Anywhere
Nexus Health Systems is seeking an experienced Utilization Review Registered Nurse (UR RN) to join our growing Utilization Management team. This fully remote position plays a critical role in ensuring patients receive medically necessary, high-quality care while promoting appropriate resource utilization and regulatory compliance.
If you're a detail-oriented RN with experience in utilization review, case management, or behavioral health and enjoy collaborating with interdisciplinary teams to improve patient outcomes, we'd love to hear from you.
What You'll Do
  • Conduct concurrent and retrospective utilization reviews to determine medical necessity and appropriate level of care.
  • Apply evidence-based criteria, including InterQual (or similar), to support clinical decision-making and payer compliance.
  • Collaborate with physicians, case managers, and interdisciplinary teams to facilitate timely authorizations, discharge planning, and appropriate transitions of care.
  • Review clinical documentation to ensure accuracy, completeness, and compliance with payer and regulatory requirements.
  • Manage insurance authorizations, denials, appeals, and level-of-care determinations.
  • Monitor utilization trends and contribute to quality improvement initiatives that enhance patient outcomes and operational efficiency.
  • Participate in multidisciplinary utilization review meetings and provide recommendations to optimize care delivery.
  • Maintain accurate documentation within the electronic health record (EHR) while ensuring HIPAA compliance.
Qualifications
Required
  • Associate Degree in Nursing (ADN) from an accredited nursing program.
  • Current, unrestricted Texas RN license or Compact RN license.
  • Minimum of 2 years of acute care clinical nursing experience.
  • At least 3 years of Utilization Review or Case Management experience involving complex medical/surgical and/or behavioral health patients.
  • Strong knowledge of payer guidelines, medical necessity criteria, and utilization management principles.
  • Excellent critical thinking, communication, and organizational skills.
  • Proficiency with electronic health records (EHRs) and Microsoft Office applications.
Preferred
  • Bachelor of Science in Nursing (BSN).
  • Experience with InterQual or MCG criteria.
  • Behavioral health utilization review experience.
  • Experience with Meditech.
  • Professional certifications such as CCM, CPHQ, or HCQM.
Why Nexus Health Systems?
At Nexus Health Systems, our mission is to improve lives through compassionate, high-quality care. As a member of our Utilization Review team, you'll collaborate with dedicated healthcare professionals while helping ensure patients receive the right care at the right time.
We offer:
  • Competitive compensation
  • Comprehensive medical, dental, and vision benefits
  • Paid time off and company holidays
  • 401(k) with company match
  • Professional development and continuing education opportunities
  • A collaborative, mission-driven culture
  • Fully remote work environment

If you're ready to make a meaningful impact in healthcare while enjoying the flexibility of working remotely, we'd love to hear from you.
Apply today through LinkedIn or visit the Nexus Health Systems Careers page to learn more.

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