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Home Based Utilization Review Nurse Jobs (NOW HIRING)

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 ...

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

$55 - $90/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

$55 - $90/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

Utilization Review Nurse

Bradenton, FL

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 ...

Pride Health

Utilization Review Nurse

Queens, NY · On-site

$2.8K/wk

Collaborate with facility-based healthcare staff, interdisciplinary treatment teams, and ... auto, home insurance, pet insurance, and employee discounts with preferred vendors. Equal ...

Pride Health

Utilization Review Nurse

Manhattan, NY · On-site

$60 - $61/hr

... nursing experience * Experience in Care Coordination, Utilization Review, and Discharge Planning ... auto, home insurance, pet insurance, and employee discounts with preferred vendors. Equal ...

Albany Medical College

$77 - $119/hr

... based on Departmental standards. • While performing utilization review identifies areas for ... home care in a high volume, acute care hospital preferred. PRI and • Case Management ...

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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

Access Healthcare Staffing & Recruitment

Las Vegas, NV • On-site

$55 - $87/hr

Other

This job post has expired today. Applications are no longer accepted.

Job description

Utilization Review Nurse (RN)

Las Vegas, NV | Full-Time

Salary: $40 – $63/hour

Position Summary

Reviews patient admissions for medical necessity, appropriate resource utilization, and compliance with payer guidelines. Analyzes medical records to ensure care meets established clinical and regulatory standards.

Requirements Education/Experience
  • Graduate of an accredited nursing program
  • 5+ years of acute care nursing experience
  • At least 1 year in Utilization Management, Case Management, or CDI
  • Minimum 3 years of Utilization Management experience
  • 3+ years of discharge planning experience in acute care
Licensure
  • Active Nevada RN license
Additional Requirements
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman criteria
Key Skills & Knowledge
  • Utilization review criteria (InterQual/Milliman), Medicare/Medicaid guidelines
  • Chart review and clinical documentation analysis
  • Regulatory compliance and hospital standards
  • Strong communication, collaboration, and analytical skills
Work Environment
  • Office-based with extended sitting and computer use
  • May require shifts and weekends
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