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Independent Contractor Remote Utilization Management Nurse Jobs in Raleigh, NC

Liveops

Remote Customer Service Agent

Apex, NC · Remote

$11.75 - $15.75/hr

Customer Service Agent -- Independent Contractor (Remote) Location: Remote (US-Based) Liveops is seeking independent contractors to provide virtual customer service support for a variety of client ...

Liveops

Remote Customer Service Agent

Durham, NC · Remote

$15 - $20/hr

Customer Service Agent -- Independent Contractor (Remote) Location: Remote (US-Based) Liveops is seeking independent contractors to provide virtual customer service support for a variety of client ...

Liveops

Remote Customer Service Agent

Raleigh, NC · Remote

$15 - $20.25/hr

Customer Service Agent -- Independent Contractor (Remote) Location: Remote (US-Based) Liveops is seeking independent contractors to provide virtual customer service support for a variety of client ...

Liveops

Remote Customer Service Agent

Chapel Hill, NC · Remote

$13.25 - $17.75/hr

Customer Service Agent -- Independent Contractor (Remote) Location: Remote (US-Based) Liveops is seeking independent contractors to provide virtual customer service support for a variety of client ...

Liveops

Remote Customer Service Agent

Cary, NC · Remote

$14.25 - $19.25/hr

Customer Service Agent -- Independent Contractor (Remote) Location: Remote (US-Based) Liveops is seeking independent contractors to provide virtual customer service support for a variety of client ...

Liveops

Remote Customer Service Agent

Wake Forest, NC · Remote

$13.25 - $17.75/hr

Customer Service Agent -- Independent Contractor (Remote) Location: Remote (US-Based) Liveops is seeking independent contractors to provide virtual customer service support for a variety of client ...

Promoted2

Remote Insurance Agent

Durham, NC · Remote

$60K - $110K/yr

Manage client pipeline using our CRM system * Follow up to ensure satisfaction and policy retention ... Background in remote or independent contracting roles * Leadership or team-building experience ...

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Independent Contractor Remote Utilization Management Nurse information

See Raleigh, NC salary details

$20

$41

$67

How much do independent contractor remote utilization management nurse jobs pay per hour?

As of Aug 4, 2026, the average hourly pay for independent contractor remote utilization management nurse in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.

How does an independent contractor remote utilization management nurse typically collaborate with healthcare teams while working remotely?

As an Independent Contractor Remote Utilization Management Nurse, you will regularly communicate and collaborate with physicians, case managers, and other healthcare professionals through secure digital platforms, email, and conference calls. Despite working remotely, strong teamwork is essential for reviewing patient cases, discussing complex situations, and ensuring appropriate care decisions. Maintaining clear and timely communication, as well as building professional relationships with both internal and external stakeholders, helps facilitate efficient utilization reviews and high-quality patient care. You may also attend virtual team meetings and contribute to interdisciplinary discussions to stay aligned with organizational goals.

What is the difference between Independent Contractor Remote Utilization Management Nurse vs Utilization Review Nurse?

AspectIndependent Contractor Remote Utilization Management NurseUtilization Review Nurse
CredentialsRN license, certification in case management or utilization review often preferredRN license, certification in case management or utilization review often required
Work EnvironmentRemote, independent contractor basis, flexible scheduleTypically employed by healthcare organizations, may be remote or onsite
Employer & Industry UsageContract basis, used by insurance companies, healthcare providers, or third-party administratorsFull-time or part-time employee, used within hospitals, insurance companies, or managed care organizations

The main difference is that the Independent Contractor Remote Utilization Management Nurse works on a contract basis, often remotely, providing specialized review services independently. In contrast, the Utilization Review Nurse is usually employed directly by healthcare organizations or insurers, with a more structured work environment. Both roles require similar credentials and focus on evaluating medical necessity and appropriateness of care.

What is an independent contractor remote utilization management nurse?

An Independent Contractor Remote Utilization Management Nurse is a licensed nurse, typically a registered nurse (RN), who works remotely as a contractor rather than a full-time employee. Their primary responsibilities include reviewing medical records, evaluating the necessity and efficiency of healthcare services, and ensuring that patient care aligns with established guidelines and insurance requirements. These nurses communicate with healthcare providers to facilitate approvals or denials of medical services, often for insurance companies or third-party administrators. Working remotely allows for schedule flexibility and the ability to serve multiple clients, but also requires strong organizational and communication skills.

What are the key skills and qualifications needed to thrive as an independent contractor remote utilization management nurse?

To thrive as an Independent Contractor Remote Utilization Management Nurse, you need a current RN license, clinical experience (often in acute care), and strong knowledge of utilization review processes. Familiarity with case management software, electronic medical records (EMRs), and industry-standard guidelines like Milliman or InterQual is typically required. Exceptional time management, critical thinking, and effective communication skills help you excel when working independently and collaborating virtually with healthcare teams. These competencies ensure accurate utilization reviews, regulatory compliance, and optimal patient care outcomes in a remote setting.
What are popular job titles related to Independent Contractor Remote Utilization Management Nurse jobs in Raleigh, NC? For Independent Contractor Remote Utilization Management Nurse jobs in Raleigh, NC, the most frequently searched job titles are:
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What cities near Raleigh, NC are hiring for Independent Contractor Remote Utilization Management Nurse jobs? Cities near Raleigh, NC with the most Independent Contractor Remote Utilization Management Nurse job openings:
Independent Contractor Remote Utilization Management Nurse jobs near you

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Posted 27 days ago

Job description

About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
•    Collaborates with healthcare partners to ensure timely review of services and care.
•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.
•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
•    Duties as assigned.
Essential Qualifications
•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
•    Must be able to work independently.
•    Must be detail oriented and have strong organizational and time management skills.
•    Adaptive to a high pace and changing environment- flexibility in assignment.
•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
•    Proficient in MCG and CMS criteria sets
•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
•    Working knowledge of URAC and NCQA.
•   2+ years’ experience in a UM team within managed care setting.
•   3+ years’ experience in clinical nurse setting preferred.
•   TPA Experience preferred.
 

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