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Home Based Utilization Review Nurse Jobs (NOW HIRING)

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

... it is based on accepted standards * Provides information to external review organizations ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...

silvercross

Utilization Review Nurse

New Lenox, IL

$34.73 - $45.15/hr

... it is based on accepted standards * Provides information to external review organizations ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

Utilization Review Nurse Remote Ability to travel on-site to 3031 NE Stephens St., Roseburg OR ... evidence-based care for members. This role conducts prior authorizations, facilitates care ...

University of Utah

Utilization Review Nurse

... based patient care focusing on the medical necessity and efficiency of the delivery of such care ... utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... evidence-based care for members. This role conducts prior authorizations, facilitates care ...

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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 Aug 9, 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 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.
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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 83% Full Time, 5% Part Time, and 12% Contract. Highlights an 76% In-person, 2% Hybrid, and 22% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Shannon Health

Big Spring, TX • On-site

Full-time

Re-posted 15 days ago

Job description

Job Summary
The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. This individual is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported. There will be interaction with providers, patient, and the care team for continued UM process. Further job duties will include Denial prevention, denial management, Implementation of process improvements to mitigate payer denials & improve front-end processes, Collaboration with internal Physician Advisor and external physician advisors regarding physician practices (particularly documentation deficiencies/admission practices). This individual identifies, develops, and provides orientation, and training, for appropriate staff and colleagues on an ongoing basis. He/she actively participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff. This individual maintains current and accurate knowledge regarding commercial and government payers and CIHQ regulations/guidelines/criteria related to UM. The UR Nurse effectively and efficiently manages a diverse workload in a dynamic regulatory environment. The UR Nurse is a member of, and provides support to, the hospital's UR Committee. He/she collaborates with multiple leaders at various levels throughout Shannon Health, for the purpose of supporting and improving the UM program.
Qualifications
Education
  • Required
    • High School Diploma, GED, or equivalent
    • Associate's degree in Nursing
  • Preferred
    • Bachelor's degree in Nursing

Experience:
  • Required
    • Five years of experience in Clinical Nursing
  • Preferred
    • Three years of experience in Inpatient Utilization Review

Certification/Licensure:
  • Required
    • Registered Nurse (RN), with authorization to practice in the State of Texas
  • Preferred
    • Accredited Case Manager (ACM) through ACMA
    • Certified Case Manager (CCM) through CCMC

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