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Full Time Remote Utilization Review Jobs (NOW HIRING)

Medica

Utilization Management RN III

$70K - $120K/yr

Medica's Utilization Review Nurses are responsible for reviewing and documenting prior ... Active, unrestricted RN license required This position is a Remote role. To be eligible for ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... 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

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... 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

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... 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

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... 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

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

TEEMA

RN Clinical Quality Reviewer

Phoenix, AZ · Remote

$40 - $43/hr

Job Summary RN Clinical Quality Reviewer TEEMA Full-time Remote | Phoenix, AZ, United States ... Review medical records to identify potential quality, safety, and utilization concerns * Conduct ...

Astrana Health, Inc.

$34 - $47/hr

HS - UM Employment Type: Full Time Location: 600 City Parkway West 10th Floor, Orange, CA 92868 ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

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Showing results 41-60

All JobsUtilization Review JobsFull Time Remote Utilization Review Jobs

Full Time Remote Utilization Review information

See salary details

$21

$42

$68

How much do full time remote utilization review jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for full time 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 is the difference between Full Time Remote Utilization Review vs Part Time Remote Utilization Review?

AspectFull Time Remote Utilization ReviewPart Time Remote Utilization Review
Work HoursTypically 40 hours/weekFewer hours, often less than 20/week
CertificationsRequired certifications like AAHAM or URAC often neededSame certifications as full-time, but may vary by employer
Work EnvironmentRemote, full-time employmentRemote, part-time engagement
Job ResponsibilitiesComplete utilization reviews, documentation, complianceSimilar responsibilities but on a reduced schedule

Full Time Remote Utilization Review involves working 40 hours weekly with comprehensive responsibilities, while Part Time Remote Utilization Review offers flexible, reduced hours with similar duties. Both roles require relevant certifications and are performed remotely, but differ mainly in hours and workload.

More about Full Time Remote Utilization Review jobs
What cities are hiring for Full Time Remote Utilization Review jobs? Cities with the most Full Time Remote Utilization Review job openings:
What are the most commonly searched types of Remote Utilization Review jobs? The most popular types of Remote Utilization Review jobs are:
What job categories do people searching Full Time Remote Utilization Review jobs look for? The top searched job categories for Full Time Remote Utilization Review jobs are:
Full Time Remote Utilization Review jobs near you

UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)

Alliance

Morrisville, NC • On-site, Remote

$69K - $88K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 18 days ago

Job description

The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services, monitors consumer treatment through ongoing and continuous review to ensure that services are delivered based on consumer need and established clinical guidelines, and identifies and follows-up on clinical cases of concern and high-risk/special needs consumers to ensure enrollees are linked to appropriate treatment resources. The UM Clinical Specialist RN - PH may represent the unit in cross agency collaborative needs.
This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to one of the offices for business or onsite team meetings as needed.
Responsibilities & Duties
Assesses the medical necessity of services
  • Independently conduct medical necessity reviews of service requests submitted by service providers against developed clinical guidelines within contractually mandated turn-around times
  • Ensure authorized services address appropriate service needs, intensity of service outcomes, and alternatives for consumers
  • Provide a consistent application of medical necessity criteria for physical health services that promotes a holistic review of the member's needs
  • Conduct pre-certification, concurrent, and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts
  • Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice standards
  • Notify members of adverse benefit determinations while preserving members' Due Process rights
  • Ensure compliance with performance measures outlined within all accrediting body standards
  • Perform other related duties as required by the immediate supervisor or other designated Alliance Health administrators

Compliance
  • Comply with utilization management and quality improvement policies and procedures, utilization review laws and regulations, state standards
  • Comply with Utilization Management Department focus on timeliness, effectiveness, quantity, quality, and cost of services for eligible enrollees

Coordinate and Implement UM Processes
  • Participate in the integration of the department and its functions into the organization's primary mission
  • Take part in the Utilization Management Department collaboration to ensure an integrated department with Physical Health and Behavioral Health

Collaborate with other departments
  • Monitor for undesirable performance or deviations of practice standards that may have a negative impact on consumers.
  • Respond through additional follow-up with consumer and providers, provider technical assistance and/or referral to other departments within the MCO.
  • Maintain open, timely communication with staff, providers, community agencies and other stakeholders

Minimum Requirements
Education & Experience
Graduation from a State accredited school of nursing or an Associate's Degree in Nursing from an accredited and five years of experience with five (5) years nursing experience
OR
Bachelor's degree in Nursing from an accredited college/university and three (3) years of nursing experience
Special Requirement
Current, active, and unrestricted North Carolina clinical license as a Registered Nurse, or a compact license
Preferred Experience:
Experience in Utilization Management
Knowledge, Skills, & Abilities
  • Knowledge of physical health and co-morbid health conditions
  • Knowledge of diagnostic treatment guidelines/protocols, level of care criteria
  • Proficient in the use of computer and multiple software programs.
  • Written and oral communication skills
  • Ability to interact with a wide variety of individuals and handle complex and confidential sensitive situations.
  • Knowledge of Utilization Management managed care principles and strategies
  • Ability to analyze effectiveness of processes and adjust developed processes.
  • Knowledge of and experience in acute clinical utilization review
  • Knowledge of Authorization/re-authorization Utilization Management standards
  • Knowledge of related duties in the delivery of patient care, management of patient care providers, or project management in a healthcare environment
  • Ability to lead, delegate and problem solve
  • Ability to develop and document workflows
  • Ability to assist appeal efforts when medical care is denied by various payor entities in a timely fashion.
  • Knowledge of and experience with NCQA

Salary Range
$69,592-$88,729/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
  • Medical, Dental, Vision, Life, Long Term Disability
  • Generous retirement savings plan
  • Flexible work schedules including hybrid/remote options
  • Paid time off including vacation, sick leave, holiday, management leave
  • Dress flexibility

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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