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Part Time Remote Utilization Review Nurse Jobs (NOW HIRING)

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 ...

Centene

Remote Medical Director, Appeals

Jefferson City, MO · 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 ...

Centene

Remote National Medical Director

Ladonia, 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 ...

Centene

Remote Medical Director, Appeals

Florissant, MO · 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 ...

Centene

Remote Medical Director, Appeals

Kansas City, MO · 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 ...

Centene

Remote National Medical Director

Bexar, 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 ...

Centene

Remote Medical Director, Appeals

Columbia, MO · 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 ...

Centene

Remote National Medical Director

Carlton, 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 ...

Centene

Remote National Medical Director

Mirando City, 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 ...

Centene

Remote Medical Director, Appeals

Saint Louis, MO · 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 ...

ChenMed

Licensed Physician Reviewer-GI (remote)

Miami, FL · Remote

$204.76K - $292.52K/yr

... Nursing Facility (SNF) meetings covering the assigned territories. * Advises other physician ... At least one (1) year of utilization review experience preferred PAY RANGE: $204,761 - $292,515 ...

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

As of May 28, 2026, the average hourly pay for part time remote 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 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 an active RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical coding systems (like ICD-10 and CPT), healthcare management software, and payer guidelines is often required. Excellent written communication, attention to detail, and the ability to work independently are essential soft skills for remote success. These competencies ensure accurate review of medical records, compliance with regulations, and effective coordination with healthcare teams while working remotely.

How do part-time remote Utilization Review Nurses typically collaborate with physicians and other healthcare professionals?

Part-time remote Utilization Review Nurses often communicate with physicians, case managers, and insurance representatives through secure digital platforms, emails, and scheduled virtual meetings. They review patient records and coordinate care authorizations, frequently clarifying clinical information or policy requirements with providers. Balancing asynchronous communication and timely responses is essential, as collaboration impacts both patient outcomes and reimbursement processes. Building strong professional relationships and maintaining clear documentation are key to effective teamwork in this remote setting.

What does a Part Time Remote Utilization Review Nurse do?

A Part Time Remote Utilization Review Nurse evaluates medical records and treatment plans to ensure that healthcare services are medically necessary and comply with insurance guidelines. Working remotely, they review patient cases, communicate with healthcare providers, and make recommendations on the appropriateness of care. Their role helps manage healthcare costs and ensures patients receive appropriate care while adhering to regulatory and insurance standards.

What is the difference between Part Time Remote Utilization Review Nurse vs Part Time Remote Case Manager?

AspectPart Time Remote Utilization Review NursePart Time Remote Case Manager
CredentialsRN license, certifications in utilization review (e.g., CUC, URAC)RN or social work license, case management certification (e.g., CCM)
Work EnvironmentRemote, reviewing medical records and authorizationsRemote, coordinating care and discharge planning
Employer & IndustryInsurance companies, healthcare providers, third-party administratorsInsurance companies, healthcare organizations, managed care firms

The Part Time Remote Utilization Review Nurse primarily evaluates medical necessity for insurance approvals, focusing on documentation review. In contrast, the Part Time Remote Case Manager manages patient care plans, coordinating services and discharge planning. Both roles are remote, require healthcare credentials, and are common in the insurance and healthcare industries, but they differ in daily responsibilities and focus areas.

More about Part Time Remote Utilization Review Nurse jobs
What cities are hiring for Part Time Remote Utilization Review Nurse jobs? Cities with the most Part Time Remote Utilization Review Nurse job openings:
What are the most commonly searched types of Remote Utilization Review Nurse jobs? The most popular types of Remote Utilization Review Nurse jobs are:
What states have the most Part Time Remote Utilization Review Nurse jobs? States with the most job openings for Part Time Remote Utilization Review Nurse jobs include:
What job categories do people searching Part Time Remote Utilization Review Nurse jobs look for? The top searched job categories for Part Time Remote Utilization Review Nurse jobs are:
Part Time Remote Utilization Review Nurse jobs near you
Infographic showing various Part Time Remote Utilization Review Nurse job openings in the United States as of May 2026, with employment types broken down into 4% As Needed, 88% Full Time, 4% Part Time, and 4% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Medical Director-Utilization Management- Independent Contractor

Capital Blue Cross

Harrisburg, PA • On-site, Remote

$100 - $150/hr

Part-time

Posted 27 days ago

Capital Blue Cross rating

7.7

Company rating: 7.7 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

174th of 258 rated insurance

Job description

Position Description
Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it's why our employees consistently vote us one of the "Best Places to Work in PA."
The Medical Director provides medical guidance and support to the full spectrum of Capital's Clinical Utilization Management activities and programs. Supports appropriate Utilization Management goals and objectives.
Provides professional leadership and direction to the functions within the Utilization Management Department.
*This is an independently contracted role, approximately 15-20 hours/week, at least one weekend every other month, as well as rotating Holiday coverage.
*To be considered, you must have a current license to practice in the state of PA
Responsibilities and Qualifications
  • Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
  • Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements
  • Engage with requesting providers as needed in peer-to-peer discussions
  • Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
  • Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
  • Makes coverage determinations in instances where requested services do not meet medical necessity criteria or where benefit exclusions require medical evaluation.
  • Makes medical necessity determinations on appeals and grievances, assuring that different reviewers conduct each level of review.
  • Provides Medical Director leadership to Vendor relationships as directed by the Managing Medical Director.
  • Supports organizational accreditation efforts and regulatory review processes: Prior- Authorization, Concurrent Review, Medical Claims Review, Case Management, Disease Management, Pharmacy Management, and Health Education programs.
  • Performs other related duties and assignments as directed.

Knowledge:
  • Knowledge of current and emerging medical treatment modalities.
  • Familiarity with National Committee for Quality/URAC standards.

Skills:
  • Demonstrated public speaking and written communication skills.

Experience:
  • A minimum of five years clinical experience, post residency, including both inpatient and outpatient care.
  • At least three years' experience in managed care, utilization review, and/or quality management.

Education, Certification, and Licenses:
  • Minimum requirements include an MD or DO Degree, as well as appropriate Board Certification.
  • Current unrestricted licensure in Pennsylvania as an MD or DO.
  • Currently covered by, or eligible to be covered by, medical liability insurance.

Physical Demands:
  • While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds.

About Us
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you'll help us live our mission of improving the health and well-being of our members and the communities in which they live.

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