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From Home Utilization Management Jobs (NOW HIRING)

INTUS INC

Utilization Management Nurse

$80K - $95K/yr

Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual ...

CVS Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ... UM Nurse Consultant Fully Remote- WFH Schedule - 4x10's- Thursday, Saturday, Sunday, Monday 8A-7P ...

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

CVS Health

MI · On-site

$29.10 - $62.32/hr

UM Nurse Consultant Fully Remote- WFH Schedule : Monday-Friday 10:30AM- 7:30PM Position Summary: UM ... Utilization Management experience Education Associates Degree in Nursing required BSN preferred ...

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All JobsUtilization Management JobsFrom Home Utilization Management Jobs

From Home Utilization Management information

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$39K

$89.5K

$163K

How much do from home utilization management jobs pay per year?

As of Aug 16, 2026, the average yearly pay for from home utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What is the difference between From Home Utilization Management vs From Home Case Management?

AspectFrom Home Utilization ManagementFrom Home Case Management
CertificationsCPUR, CCM, or similarCPUR, CCM, or similar
Work EnvironmentRemote, healthcare insurance companiesRemote, healthcare insurance companies
Primary FocusReviewing medical necessity and resource utilizationCoordinating patient care and services
Employer UsageHealth insurers, managed care organizationsHealth insurers, managed care organizations

From Home Utilization Management primarily focuses on evaluating medical necessity and resource utilization, ensuring appropriate healthcare services. In contrast, From Home Case Management emphasizes coordinating patient care and services to support health outcomes. Both roles are remote, require similar certifications, and are used within healthcare insurance companies, but their core responsibilities differ.

What cities are hiring for From Home Utilization Management jobs?

Cities with the most From Home Utilization Management job openings:

What are the most commonly searched types of Utilization Management jobs?

The most popular types of Utilization Management jobs are:

What states have the most From Home Utilization Management jobs?

States with the most job openings for From Home Utilization Management jobs include:

From Home Utilization Management jobs near you

RN, Utilization Management | Utilization Management| Night | Part Time

UF Health

Gainesville, FL • On-site

Part-time

Re-posted 27 days ago

Job description

Overview

Make an impact by supporting the right care at the right time through utilization management excellence. 

???? Work Style: Onsite
???? Location: Gainesville, FL 
???? FTE:  Part-Time (.6 FTE)
⏰ Schedule: Wednesday – Thursday - 7:00 PM – 7:00 AM

Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.


Responsibilities
Key Responsibilities
  • Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services.
  • Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements.
  • Supports effective treatment planning, patient care coordination, and appropriate resource utilization.
  • Communicates authorization decisions and utilization determinations while supporting timely discharge planning efforts.
  • Analyzes utilization management data and trends to identify opportunities for improved care coordination and operational efficiency.
  • Collaborates with interdisciplinary teams to ensure accurate documentation, regulatory compliance, and quality patient outcomes.

Qualifications
Education & Licensure
  • Registered Nurse (RN) with a current Florida nursing license required.
Experience & Skills
  • Minimum of three (3) years of experience in utilization review, utilization management, or case management required.
  • Knowledge of healthcare utilization guidelines, payer requirements, and regulatory compliance standards.
  • Experience evaluating medical necessity, treatment plans, and appropriate levels of care.
  • Strong communication and collaboration skills related to authorization determinations and care coordination.
  • Demonstrated ability to analyze utilization data, identify trends, and support patient care and discharge planning initiatives.

Apply