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Part Time Remote Utilization Review Jobs (NOW HIRING)

Two Chairs

Part-Time Remote Therapist

Oakland, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Two Chairs

Part-Time Remote Therapist

San Jose, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Two Chairs

Part-Time Remote Therapist

San Francisco, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Two Chairs

Part-Time Remote Therapist

Los Angeles, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Two Chairs

Part-Time Remote Therapist

Irvine, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Two Chairs

Part-Time Remote Therapist

San Diego, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Two Chairs

Part-Time Remote Therapist

Fresno, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Two Chairs

Part-Time Remote Therapist

Sacramento, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Two Chairs

Part-Time Remote Therapist

Long Beach, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Two Chairs

Part-Time Remote Therapist

Riverside, CA · Remote

$85/hr

Deliver remote, evidence-based therapy to adult clients (18+), practicing modalities like CBT, DBT ... Application Review: We'll promptly review your application to ensure you meet the minimum ...

Centene

Remote National Medical Director

Afton, TX · On-site +1

$236.50K - $449.30K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... or part-time status. Total compensation may also include additional forms of incentives. Benefits ...

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Part Time Remote Utilization Review information

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How much do part time remote utilization review jobs pay per hour?

As of May 30, 2026, the average hourly pay for part time remote 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 are the key skills and qualifications needed to thrive as a Part Time Remote Utilization Review Nurse, and why are they important?

To thrive as a Part Time Remote Utilization Review Nurse, you need a current RN license, strong clinical judgment, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and systems such as InterQual or MCG is typically required. Excellent communication, critical thinking, and self-motivation are vital soft skills for coordinating care and making independent decisions remotely. These skills ensure accurate case evaluations, regulatory compliance, and effective collaboration with healthcare teams while working from a remote setting.

What are the typical challenges faced by part-time remote utilization review professionals, and how can they be managed?

Part-time remote utilization review professionals often face challenges such as balancing a variable workload, ensuring timely communication with healthcare providers, and staying current with changing insurance guidelines. Since much of the work is done independently, strong time management and self-motivation are essential to meet review deadlines. Regularly scheduled check-ins with the team and utilizing digital collaboration tools can help maintain connectivity and support. Staying organized and proactive in seeking clarification when needed can mitigate common challenges and lead to a successful experience in this role.

What is a Part Time Remote Utilization Review position?

A Part Time Remote Utilization Review position involves evaluating medical records and healthcare services to ensure they are necessary and appropriate, typically for insurance companies or healthcare providers. This job is performed remotely, allowing professionals to work from home or another location outside of a traditional office setting. Part-time roles generally require fewer hours than full-time positions, making them suitable for those seeking flexible schedules. Professionals in this role often have backgrounds in nursing or healthcare and use their expertise to review patient care for quality and cost-effectiveness.

What is the difference between Part Time Remote Utilization Review vs Part Time Remote Claims Reviewer?

AspectPart Time Remote Utilization ReviewPart Time Remote Claims Reviewer
CredentialsTypically requires healthcare licenses (e.g., RN, MD) and utilization review certificationsUsually requires insurance or claims processing experience, with some industry-specific certifications
Work EnvironmentRemote, healthcare-focused, reviewing medical necessity and appropriateness of careRemote, insurance or healthcare claims processing, verifying coverage and claims accuracy
Employer & Industry UsageHospitals, insurance companies, healthcare organizationsInsurance companies, third-party administrators, healthcare payers

Part Time Remote Utilization Review and Part Time Remote Claims Reviewer both operate remotely but focus on different aspects of healthcare administration. Utilization reviewers assess medical necessity, while claims reviewers verify insurance claims. Understanding these differences helps job seekers find roles aligned with their skills and credentials.

More about Part Time Remote Utilization Review jobs
What cities are hiring for Part Time Remote Utilization Review jobs? Cities with the most Part Time 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 Part Time Remote Utilization Review jobs? States with the most job openings for Part Time Remote Utilization Review jobs include:
What job categories do people searching Part Time Remote Utilization Review jobs look for? The top searched job categories for Part Time Remote Utilization Review jobs are:
Part Time Remote Utilization Review jobs near you
Infographic showing various Part Time Remote Utilization Review job openings in the United States as of May 2026, with employment types broken down into 100% Part Time. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 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 14 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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