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Home Based Utilization Review Nurse Jobs (NOW HIRING)

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$60 - $80/hr

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated health ... Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

Utilization Review Nurse Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the ...

Randolph Health

Utilization Review Nurse

Asheboro, NC · On-site

$21.47 - $35/hr

... the Utilization Review Plan for Randolph Hospital. Review patient record and plan of care at ... Facilitate insurance approval for services needed at discharge such as home health services ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ... Benefits may vary based on subsidiary entity and geographic location. Acrisure is an Equal ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

$60 - $80/hr

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers ... Benefits may vary based on subsidiary entity and geographic location.***Acrisure is an Equal ...

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ... Benefits may vary based on subsidiary entity and geographic location. Acrisure is an Equal ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ... Benefits may vary based on subsidiary entity and geographic location. Acrisure is an Equal ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading ... Review clinical documentation and determine benefit eligibility using evidence-based clinical ...

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Home Based Utilization Review Nurse information

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How much do home based utilization review nurse jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for home based 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.

What is a home based utilization review nurse?

Home Based Utilization Review Nurses are registered nurses who work remotely, typically from their homes, to evaluate the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records, coordinate with healthcare providers, and ensure that patient care meets established guidelines and insurance requirements. These nurses play a crucial role in managing healthcare costs and improving patient outcomes by ensuring that patients receive the right level of care. They often interact with insurance companies, healthcare facilities, and patients to facilitate approvals and appeals for medical services.

How does a home based utilization review nurse typically collaborate with physicians and care teams while working remotely?

As a Home Based Utilization Review Nurse, collaboration with physicians and interdisciplinary care teams is primarily conducted through secure digital platforms, phone calls, and video meetings. You will review patient records, discuss care plans, and provide recommendations to ensure appropriate resource utilization. Effective communication skills are essential, as you'll need to clearly convey clinical findings and advocate for necessary services while balancing payer guidelines. Building strong virtual relationships and staying organized with documentation are key to overcoming the challenges of remote teamwork.

What are the key skills and qualifications needed to thrive as a home based utilization review nurse, and why are they important?

To thrive as a Home Based Utilization Review Nurse, you need a valid RN license, clinical experience, and a strong understanding of medical necessity criteria and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory standards such as Medicare or Medicaid are typically required. Critical thinking, attention to detail, and effective communication are standout soft skills for this role. These skills ensure accurate case assessments, compliance with policies, and effective collaboration, which are vital for optimizing patient outcomes and healthcare resource utilization.

What is the difference between Home Based Utilization Review Nurse vs Telehealth Nurse?

AspectHome Based Utilization Review NurseTelehealth Nurse
CredentialsRN license, possibly certifications in case management or utilization reviewRN license, may have certifications in telehealth or specialty areas
Work EnvironmentHome office, reviewing patient cases remotely for insurance or healthcare providersRemote or clinical setting providing patient care via telecommunication tools
Employer & IndustryInsurance companies, healthcare organizations, utilization review firmsHospitals, clinics, telehealth companies, healthcare providers

The Home Based Utilization Review Nurse primarily focuses on reviewing patient cases remotely to determine appropriate care and resource utilization, often for insurance purposes. In contrast, the Telehealth Nurse provides direct patient care via telecommunication platforms, offering advice, education, and clinical support. While both roles are remote and require nursing credentials, their core responsibilities and work environments differ significantly.

How to get into home based utilization review nurse?

To become a home-based utilization review nurse, candidates typically need a registered nurse (RN) license, experience in case management or utilization review, and knowledge of healthcare policies. Certification such as the Certified Professional in Healthcare Quality (CPHQ) can enhance job prospects, and strong communication skills are essential for remote work environments.
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Home Based Utilization Review Nurse jobs near you
Infographic showing various Home Based Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 16% Part Time, and 6% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UTILIZATION REVIEW NURSE

Sentara Health Plans

Norfolk, VA • On-site

$60 - $80/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

Key responsibilities

  • Conduct utilization management services including prior authorization, retrospective review, and medical director referrals.

  • Review provider requests for services requiring authorization and conduct pre-certification and care coordination to ensure treatment appropriateness.

  • Provide written and/or verbal notification to members and providers regarding approval or denial decisions.

Job description

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse. The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

Education
  • BSN (preferred)
Certification
  • Registered Nurse (required)
Experience
  • 3 years of acute care clinical experience (required)
  • Previous Utilization Review experience (preferred)
  • Milliman experience (preferred)
  • Knowledge of NCQA (preferred)
  • Microsoft suite (Word, Excel, Outlook) (preferred)
Keywords

Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA

Benefits

Caring For Your Family and Your Career

  • Medical, Dental, Vision plans
  • Adoption, Fertility and Surrogacy Reimbursement up to $10,000
  • Paid Time Off and Sick Leave
  • Paid Parental & Family Caregiver Leave
  • Emergency Backup Care
  • Long-Term, Short-Term Disability, and Critical Illness plans
  • Life Insurance
  • 401k/403B with Employer Match
  • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
  • Student Debt Pay Down – $10,000
  • Pet Insurance
  • Legal Resources Plan

Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan.

The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!

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