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From Home Utilization Management Jobs (NOW HIRING)

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$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 ...

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

Utilization Management Nurse Consultant

$29.10 - $62.32/hr

Schedule WFH- Monday through Friday 8a-5p EST/9a-6p CST with 1 hour lunch Position Summary Utilizes ... utilization/benefit management function. Required Qualifications 3+ years of experience as an RN ...

UF Health

RN, Utilization Management

Saint Johns, FL · On-site

Qualifications Graduate from an accredited Nursing school. Registered Nurse (RN) license with 3+ years experience in utilization review or case management. Knowledge of healthcare utilization ...

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From Home Utilization Management information

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$89.5K

$163K

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

As of Sep 6, 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

Utilization Management Manager-Utilization Mgmt- Days - FT

Memorial Health System

Gulfport, MS • On-site

Full-time

Re-posted 28 days ago

Job description


Oversee the management of patient care utilization, ensuring appropriate healthcare services are provided while optimizing resource use. This individual will be responsible for leading a team of nurses who review medical necessity, appropriateness and efficiency of healthcare services. Ensure compliance with regulatory requirements and maintain high standards of care.
Responsibilities
  • Supervise and lead the UM nursing team and Pre-Certification Specialists, ensuring the review of patient cases for appropriate medical necessity and care protocols
  • Develop, implement and maintain UM policies and procedures in accordance with healthcare regulation and organizational standards
  • Conduct regular training and provide ongoing support for UR team to improve knowledge and performance
  • Collaborate with physicians, other healthcare providers and insurance companies to review and improve treatment plans. Ensure all services are medically necessary and cost effective
  • Evaluate and analyze healthcare utilization trends, identify opportunities for improvement and solutions to improve outcome
  • Monitor and ensure compliance with regulatory requirements including Medicare, Medicaid and other payer policies
  • Prepare and present reports on utilization metrics, case reviews and outcomes to administration leadership groups
  • Resolve complex case issues and provide guidance on challenging utilization decisions
  • Ensure accurate documentation of all UM reviews, ensuring compliance with internal and external audit
  • Foster effective communication between departments, stakeholders and healthcare professionals

Qualifications
Education Requirements
Required: Bachelor Degree
  • Bachelor of Science in Nursing, with an active unrestricted license

Preferred: Master's Degree
  • Nursing or other clinical discipline, Health Administration, Finance, Business Administration, or a related field

License or Certification Requirements
Required: License
  • Nursing degree (RN, BS, BSN, or advanced degree) and unrestricted active nursing license

Experience Requirements
Required: 5 years
  • Nursing experience with at least 2 years in Utilization Management or case management role

Preferred: 2 years
  • Leadership or management experience in nursing or related field

Core Competencies
Knowledge:
  • In depth knowledge of healthcare utilization management processes, medical terminology and clinical guidelines
  • Familiarity with payer requirements and regulation including Medicare, Medicaid and private insurers
  • Working knowledge of applications that are used to enhance utilization management based on evidenced based approach and guidelines
  • Strong knowledge of Microsoft Office applications

Skills:
  • Analytical Skills: The ability to analyze large data sets, determine trends, synthesize results, and deliver prioritized details through effective reporting
  • Communication Skills: Strong communication and interpersonal skills for effective collaboration and education
  • Problem-Solving Skills: The capacity to understand issues, derive many potential solutions, troubleshoot discrepancies, and understand systematic approaches to problem resolution

Abilities:
  • Attention to Detail: Precision is essential when reporting critical analysis to inform decision-making and operational change
  • Time Management: Managing multiple tasks and deadlines while prioritizing work is essential in a fast-paced healthcare environment
  • Technology Proficiency: Beyond EHR systems, familiarity with various billing software and technology tools

Work Environment: This position may involve working in a variety of clinical and administrative settings, requiring adaptability and a proactive approach to problem-solving.
Physical Demands: Frequent reaching, sitting, walking, and standing may be required. No special coordination beyond that used for normal mobility and handling of everyday objects and materials is needed to perform the job.

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