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Online Remote Behavioral Health Utilization Review Jobs

Umpqua Health

Utilization Review Clinician

UTILIZATION REVIEW CLINICIAN REMOTE Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR ... Evaluate behavioral health and substance use disorder services to determine medical necessity ...

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... For positions that are available as remote work, Sentara Health employs associates in the following ...

Umpqua Health

Utilization Review Clinician

Roseburg, OR · On-site +1

$80K - $94K/yr

UTILIZATION REVIEW CLINICIAN REMOTE Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR ... Evaluate behavioral health and substance use disorder services to determine medical necessity ...

Centene

Utilization Review Clinician_Behavioral Health

$27.02 - $48.55/hr

Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Centene

Utilization Review Clinician_Behavioral Health

$27.02 - $48.55/hr

Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

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Online Remote Behavioral Health Utilization Review information

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How much do online remote behavioral health utilization review jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for online remote behavioral health utilization review 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 Online Remote Behavioral Health Utilization Review vs Online Remote Mental Health Case Manager?

AspectOnline Remote Behavioral Health Utilization ReviewOnline Remote Mental Health Case Manager
CredentialsLicenses in behavioral health, certifications in utilization reviewLicenses in mental health, case management certifications
Work EnvironmentRemote, reviewing patient records and treatment plansRemote, coordinating care and supporting patients
Employer & IndustryInsurance companies, healthcare organizationsHealthcare providers, community agencies
Primary FocusAssessing medical necessity and approving servicesSupporting patient care coordination and resource linkage

Online Remote Behavioral Health Utilization Review focuses on evaluating the necessity of behavioral health services for insurance approval, while Online Remote Mental Health Case Managers coordinate ongoing patient care and support. Both roles require behavioral health credentials and are performed remotely, but their core responsibilities differ in focus and daily tasks.

What cities are hiring for Online Remote Behavioral Health Utilization Review jobs?

Cities with the most Online Remote Behavioral Health Utilization Review job openings:

What are the most commonly searched types of Remote Behavioral Health Utilization Review jobs?

The most popular types of Remote Behavioral Health Utilization Review jobs are:

What states have the most Online Remote Behavioral Health Utilization Review jobs?

States with the most job openings for Online Remote Behavioral Health Utilization Review jobs include:

Online Remote Behavioral Health Utilization Review jobs near you
Infographic showing various Online Remote Behavioral Health Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Remote UTILIZATION REVIEW NURSE - RN

Remote

Nexus Health Systems
Health Care and Social Assistance • 501 - 1,000 employees

6.3

Company rating: 6.3 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Respectful managers

Learn more about Nexus Health Systemsexternal

Other

Medical, Dental, Vision, Retirement, PTO

Posted 14 days ago

Job description

Remote Utilization Review Registered Nurse (UR RN)
Location: Remote (Texas RN License or Compact License Required)
Company: Nexus Health Systems
Employment Type: Full-Time
Make an Impact from Anywhere
Nexus Health Systems is seeking an experienced Utilization Review Registered Nurse (UR RN) to join our growing Utilization Management team. This fully remote position plays a critical role in ensuring patients receive medically necessary, high-quality care while promoting appropriate resource utilization and regulatory compliance.
If you're a detail-oriented RN with experience in utilization review, case management, or behavioral health and enjoy collaborating with interdisciplinary teams to improve patient outcomes, we'd love to hear from you.
What You'll Do
  • Conduct concurrent and retrospective utilization reviews to determine medical necessity and appropriate level of care.
  • Apply evidence-based criteria, including InterQual (or similar), to support clinical decision-making and payer compliance.
  • Collaborate with physicians, case managers, and interdisciplinary teams to facilitate timely authorizations, discharge planning, and appropriate transitions of care.
  • Review clinical documentation to ensure accuracy, completeness, and compliance with payer and regulatory requirements.
  • Manage insurance authorizations, denials, appeals, and level-of-care determinations.
  • Monitor utilization trends and contribute to quality improvement initiatives that enhance patient outcomes and operational efficiency.
  • Participate in multidisciplinary utilization review meetings and provide recommendations to optimize care delivery.
  • Maintain accurate documentation within the electronic health record (EHR) while ensuring HIPAA compliance.
Qualifications
Required
  • Associate Degree in Nursing (ADN) from an accredited nursing program.
  • Current, unrestricted Texas RN license or Compact RN license.
  • Minimum of 2 years of acute care clinical nursing experience.
  • At least 3 years of Utilization Review or Case Management experience involving complex medical/surgical and/or behavioral health patients.
  • Strong knowledge of payer guidelines, medical necessity criteria, and utilization management principles.
  • Excellent critical thinking, communication, and organizational skills.
  • Proficiency with electronic health records (EHRs) and Microsoft Office applications.
Preferred
  • Bachelor of Science in Nursing (BSN).
  • Experience with InterQual or MCG criteria.
  • Behavioral health utilization review experience.
  • Experience with Meditech.
  • Professional certifications such as CCM, CPHQ, or HCQM.
Why Nexus Health Systems?
At Nexus Health Systems, our mission is to improve lives through compassionate, high-quality care. As a member of our Utilization Review team, you'll collaborate with dedicated healthcare professionals while helping ensure patients receive the right care at the right time.
We offer:
  • Competitive compensation
  • Comprehensive medical, dental, and vision benefits
  • Paid time off and company holidays
  • 401(k) with company match
  • Professional development and continuing education opportunities
  • A collaborative, mission-driven culture
  • Fully remote work environment

If you're ready to make a meaningful impact in healthcare while enjoying the flexibility of working remotely, we'd love to hear from you.
Apply today through LinkedIn or visit the Nexus Health Systems Careers page to learn more.

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