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Internship Remote Utilization Review Jobs (NOW HIRING)

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

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 ...

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

Remote : Mondays and Fridays * On-site in our Denver Office: Tuesdays, Wednesdays, and Thursdays The compensation range for this position is based upon candidate experience and market expectations.

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At Umpqua ...

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

... all Utilization Management activities to include review of inpatient and outpatient medical ... Remote Contract to Hire VIVA is an equal opportunity employer. All qualified applicants have an ...

UK St Claire

Utilization Review Nurse

Morehead, KY · On-site +1

Supports utilization review processes by planning, analyzing data, and setting goals to ensure ... Volunteer work and internships for academic credit are not counted. Certifications & Licensures ...

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Internship Remote Utilization Review information

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How much do internship remote utilization review jobs pay per hour?

As of Jun 8, 2026, the average hourly pay for internship remote utilization review in the United States is $19.31, according to ZipRecruiter salary data. Most workers in this role earn between $16.11 and $20.91 per hour, depending on experience, location, and employer.

What are the main challenges interns face when working remotely in Utilization Review, and how can they overcome them?

Remote Utilization Review interns often encounter challenges in balancing independent work with effective communication, especially when collaborating with clinical teams or supervisors. Staying organized and proactively reaching out for guidance can help bridge gaps caused by remote settings. Utilizing available digital tools, attending virtual meetings, and participating in team chats fosters connection and learning. Setting a structured daily schedule and seeking regular feedback ensures that interns stay aligned with team goals and develop their review skills efficiently.

What is a Remote Utilization Review Internship?

A Remote Utilization Review Internship is a temporary position, often for students or recent graduates, that allows individuals to work remotely while learning about utilization review processes in healthcare. Interns assist in evaluating medical records, ensuring that healthcare services provided to patients are medically necessary and meet established guidelines. They work under the supervision of licensed professionals, gaining experience in medical documentation, insurance policies, and healthcare regulations. This role is ideal for those interested in healthcare administration, nursing, or case management.

What is the difference between Internship Remote Utilization Review vs Utilization Review Specialist?

AspectInternship Remote Utilization ReviewUtilization Review Specialist
CredentialsTypically pursuing or holding relevant certifications (e.g., CCM, RN)Requires active certification and experience in utilization review
Work EnvironmentRemote, internship setting, often part-time or supervisedFull-time, remote or onsite, with more independent responsibilities
Industry UsageEntry-level, training phase within healthcare and insurance sectorsProfessional role with established responsibilities in healthcare management

In summary, an Internship Remote Utilization Review is a training position for individuals gaining experience in utilization review, often with supervision and limited responsibilities. A Utilization Review Specialist is a fully qualified professional responsible for evaluating healthcare services, requiring certifications and more independence in their role.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review Intern, and why are they important?

To thrive as a Remote Utilization Review Intern, you need a foundational understanding of healthcare processes, medical terminology, and insurance guidelines, often supported by a relevant degree or coursework in nursing, health administration, or a related field. Familiarity with electronic medical record (EMR) systems, utilization review software, and HIPAA compliance is typically required. Strong attention to detail, analytical thinking, and effective written communication are standout soft skills in this role. These abilities are crucial for accurately reviewing patient cases, ensuring regulatory compliance, and supporting efficient healthcare delivery from a remote setting.
More about Internship Remote Utilization Review jobs
What cities are hiring for Internship Remote Utilization Review jobs? Cities with the most Internship Remote Utilization Review job openings:
What are the most commonly searched types of Remote Utilization Review jobs? The most popular types of Remote Utilization Review jobs are:
What states have the most Internship Remote Utilization Review jobs? States with the most job openings for Internship Remote Utilization Review jobs include:
What job categories do people searching Internship Remote Utilization Review jobs look for? The top searched job categories for Internship Remote Utilization Review jobs are:
Internship Remote Utilization Review jobs near you
Infographic showing various Internship Remote Utilization Review job openings in the United States as of May 2026, with employment types broken down into 6% Internship, 53% Full Time, and 41% Part Time. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $40,174 per year, or $19.3 per hour.

REMOTE Utilization Review Nurse - Managed Care

DOCS Management Services

Coos Bay, OR • Remote

$35.29 - $47.37/hr

Full-time, Part-time

Medical

Posted 23 days ago

Job description

We are currently hiring a Part-time REMOTE Utilization Review Nurse! If you are a licensed nurse with excellent critical thinking skills, have experience in acute care settings and utilization review, and value being part of a team that makes a difference, you may be the right person for the position! Apply today!

Classification: NON-EXEMPT | Status amp; Schedule: PART-TIME, 20-HRS/WEEK, GENERALLY MONDAY – FRIDAY, BUT MAY INCLUDE ADDITIONAL HOURS TO MEET THE NEEDS OF THE POSITION
Location: REMOTE, LOCAL TO OREGON STRONGLY PREFERRED
Work Location: OR, CA, AZ, TX, FL
Salary: $35.29 - $47.37/HOURLY
Department: MEDICAL SERVICES/UTILIZATION REVIEW | Reports to: DIRECTOR OF MEDICAL SERVICES | Supervision Exercised: NON-SUPERVISORY
JOB PURPOSE: Utilization Review Nurse
The Clinical Review Nurse is responsible for providing clinically efficient and effective utilization management. Reviews prior authorization requests for appropriate care and setting by following evidence based clinical guidelines, medical necessity criteria and health plan guidelines. Reviews and applies hierarchy of criteria to all referral and preauthorization requests from the PCP's and specialists that require a medical necessity determination. Is involved in assuring that the patient receives high-quality cost-effective care. Uses sound clinical judgement and managed care principles in the coordination of care. Prepares any case that does not meet medical necessity guidelines for medical appropriateness of procedure, service, or treatment for review with the Physician Reviewer for a decision.
QUALIFICATIONS, EDUCATION, and EXPERIENCE
  • Nursing degree from an accredited nursing program
  • Unrestricted Oregon RN license
  • Experience with a similar population in health plans or managed care
  • Experience administering OHP, Medicare benefits or utilization review highly preferred.
ESSENTIAL RESPONSIBILITIES: Licensed Utilization Review
  1. Maintains clinical expertise and knowledge of scientific progress in nursing and medical arena and incorporates this information into the clinical review and care coordination processes
  2. Performs clinical review for appropriate utilization of medical services by applying appropriate medical necessity criteria guidelines
  3. Authorizes healthcare services in compliance with contractual agreements, Health Plan guidelines and appropriate medical necessity criteria
  4. Provides accurate and timely documentation within internal system supporting rational of decision based on clinical review
  5. Identifies members who are appropriate for care coordination programs and collaborates with the Medical Management team for care coordination of the member's needs along the continuum of care
  6. Meets timeliness standards for referral and prior authorization activities
  7. Sends appropriate notifications for Third Party Liability (TPL) and/or possible Stop Loss
  8. Forward relevant information of members requiring special interventions to Advanced Health
  9. Participate in quality and organizational process improvement activities and teams when requested
  10. Assist in audit preparation as directed
  11. Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
  12. Handle confidential information and materials appropriately and maintains a secure work area
  13. Maintains the confidentiality of all company procedures, results, and information about patients, contracts, and all other proprietary information regarding company business.
  14. Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
  15. Handle confidential information and materials appropriately and maintain a secure work area
  16. Other duties as assigned
ESSENTIAL RESPONSIBILITIES: ORGANIZATIONAL TEAM MEMBER
  • Participate in quality and organizational process improvement activities and teams when requested
  • Support and contribute to effective safety, quality, and risk management efforts by adhering to established; policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities
  • Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner
  • Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization
  • Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations
  • Recognize new developments and remain current in [position’s expertise] best practice standards and anticipate organizational modifications
  • Advance personal knowledge base by pursuing continuing education to enhance professional competence
  • Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
  • Represent organization at meetings and conferences as applicable
KNOWLEDGE, SKILLS, and ABILITIES
  • Knowledge of OHP program requirements, benefit package, eligibility categories, and Oregon Division of Medical Assistance Program (MAP) rules and regulations preferred
  • Knowledge of ICD, CPT, and HCPCS codes
  • Proficient in Milliman Clinical Guidelines (MCG)
  • Strong attention to detail
  • Ability to think and work independently with minimum supervision
  • Provide critical attention to detail for accuracy and timeliness
  • Ability to manage multiple tasks and remain flexible in a dynamic work environment
  • Ability to report to work as scheduled, and willingness to work a flexible schedule when needed
  • Proficient in Microsoft Office Suite and Windows Operating System (OS)
  • Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access
  • Knowledge and understanding of how the positions’ responsibilities contribute to the department and company goals and mission
  • Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
  • Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices
  • Excellent people skills and friendly demeanor
  • Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
  • Attention to detail and organization skills
  • Ability to handle stress and sensitive situations effectively while projecting a professional attitude
  • Ability to communicate professionally, both conversing and written
  • Ability to work with diverse populations and interact with people of differing personalities and backgrounds
  • Sensitive to economic considerations, human needs and aware of how one’s actions may affect others
  • Ability to organize and work in a sensitive manner with people from other cultures
  • Poised; maintains composure and sense of purpose
WORKING CONDITIONS
This position must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information.
Work Condition: Remote Work Environment
  • Employee generally works within a remote work from home environment.
  • Travel may be required on occasion.
  • Hours of operations and specific staff scheduling may vary based on operational need.
Exposed to:
  • Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output.
  • Machines, equipment, tools, and supplies used: Constantly operates a computer or other office productivity machinery or software, such as fax, copier, calculator, multi-line telephone system, or scanner.
  • May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information.
Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task.
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of DOCS Management Services employees. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

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