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Home Based Utilization Review Nurse Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

While your daily work will be completed from your home office, occasional travel may be required ... based guidelines * Meet required decision-making SLAs * Refer members for further care engagement ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

While your daily work will be completed from your home office, occasional travel may be required ... based guidelines * Meet required decision-making SLAs * Refer members for further care engagement ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

While your daily work will be completed from your home office, occasional travel may be required ... based guidelines * Meet required decision-making SLAs * Refer members for further care engagement ...

AbsoluteCARE

Utilization Review Nurse

New Orleans, LA · On-site

... home nursing as well as others. Ensures medically appropriate, high quality, cost effective care ... care plans based on assessment of member's clinical and social needs. * Reviews and interprets ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

... home nursing as well as others. Ensures medically appropriate, high quality, cost effective care ... care plans based on assessment of member's clinical and social needs. * Reviews and interprets ...

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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 Jul 26, 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 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.

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 are Home Based Utilization Review Nurses?

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.
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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 July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse RN - PRN

Utilization Review Nurse RN - PRN

LifeBridge Health

Westminster, MD • On-site

$50 - $52.50/hr

Per diem

PTO

Posted 26 days ago

LifeBridge Health rating

6.2

Company rating: 6.2 out of 10

Based on 79 frontline employees who took The Breakroom Quiz

701st of 890 rated healthcare providers

Job description

Summary
Position Summary
The Utilization Review Nurse is responsible for conducting initial, concurrent, and retrospective medical record reviews to evaluate the appropriateness of patient care, resource utilization, and reimbursement. This role collaborates closely with Care Management, physicians, patient access, financial counselors, and third-party payers to ensure accurate clinical documentation, timely authorization, and effective coordination of care while minimizing avoidable delays and payment denials.
Key Responsibilities
  • Perform initial, concurrent, and retrospective utilization reviews using established clinical criteria to evaluate medical necessity, level of care, and resource utilization.
  • Review medical records for clinical, financial, and utilization management information and accurately document findings in the designated utilization management software.
  • Communicate with third-party payers to obtain certifications, authorizations, and continued stay approvals by providing relevant clinical information.
  • Monitor utilization trends, identify potential or actual denials, and implement interventions to reduce avoidable delays and reimbursement issues.
  • Collaborate with Care Managers, Social Workers, physicians, financial counselors, and patient access staff to coordinate patient care and support appropriate discharge planning.
  • Assist Care Managers in communicating denied hospital days and issuing required Medicare notices, including the Hospital-Issued Notice of Noncoverage (HINN) and Detailed Notice of Discharge, to patients and families when appropriate.
  • Coordinate with Care Management to promote efficient patient throughput, optimize length of stay, and improve patient outcomes.
  • Escalate cases that do not meet medical necessity criteria to the Physician Advisor for review and recommendations.
  • Partner with the Physician Advisor and interdisciplinary team to facilitate expedited appeals and resolve payer-related issues.
  • Maintain compliance with organizational policies, payer requirements, regulatory standards, and documentation guidelines.
  • Identify opportunities for process improvement within utilization management and contribute to quality initiatives.
  • Perform other duties as assigned.
Qualifications
Required
  • Active Registered Nurse (RN) license in good standing.
  • Knowledge of utilization review, medical necessity criteria, reimbursement processes, and payer regulations.
  • Strong clinical assessment and critical thinking skills.
  • Excellent communication, documentation, and organizational skills.
  • Ability to work collaboratively with interdisciplinary teams and external payer representatives.
  • Proficiency with electronic health records (EHR) and utilization management software.
  • Previous experience in Utilization Management, Case Management, or Care Coordination.
  • Experience using InterQual®, MCG®, or other evidence-based utilization review criteria.
  • Certification in Case Management (CCM), Utilization Review (CPUR), or a related specialty preferred.
Benefits
  • Competitive PRN rate
  • Flexible Schedule
  • Paid time off and holidays
  • Collaborative and supportive work environment

What LifeBridge Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About LifeBridge Health

Sourced by ZipRecruiter

LifeBridge Health is a $2B, 13,000 team member healthcare system that Cares Bravely for over 1 million patients annually throughout Maryland. We are comprised of 5 main healthcare centers: Sinai Hospital, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital, and Grace Medical Center as well as several specialty and primary care locations throughout Baltimore.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Baltimore, MD, US

Year founded

1988

Social media

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