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Quality Review Nurse Remote Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Netsmart

Utilization Review Nurse

Review and evaluate electronic medical records of emergency department admissions and screen for ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

McBee Associates

Utilization Review Nurse

Review and evaluate electronic medical records of emergency department admissions and screen for ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

iMPROve Health

Contingent UR/LTSS Registered Nurse

This fully remote position supports Michigan Medicaid programs by conducting Nursing Facility Level of Care (LOC) reviews and Home Help quality review assessments. This role is ideal for experienced ...

CERIS Health

Itemization Review Nurse I

$52K - $85K/yr

Itemization Review Nurse The Itemization Review Nurse provides a summary and analysis of items by ... This is a remote position. Essential Functions & Responsibilities: * Collects supporting data and ...

CorVel

CA Utilization Review Nurse I

$30.64 - $45.80/hr

Utilization Review Nurse The Utilization Review Nurse gathers demographic and clinical information ... This is a remote position. Essential Functions & Responsibilities: * Identifies the necessity of ...

HandsOn Global Management

Be Seen First

UM Review Nurse

Tampa, FL · Remote

$36 - $40/hr

PURPOSE AND SCOPE: The UM Nurse Reviewer is responsible for the medical necessity review of ... Adheres to quality standards and confidentiality policies and procedures. * Ensures compliance with ...

New

University of Utah

Utilization Review Nurse

... quality and trust that are integral to our mission. EO/AA This position is responsible for ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...

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All Jobsremote JobsHealthcare JobsNursing JobsNurse Case Manager JobsQuality Review Nurse Remote Jobs

Quality Review Nurse Remote information

See salary details

$29.5K

$90.3K

$170K

How much do quality review nurse remote jobs pay per year?

As of Aug 19, 2026, the average yearly pay for quality review nurse remote in the United States is $90,275.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,500.00 and $102,500.00 per year, depending on experience, location, and employer.

What does a quality review nurse do in a remote position?

A Quality Review Nurse working remotely is responsible for reviewing medical records, ensuring compliance with healthcare regulations, and evaluating the quality of patient care provided by healthcare facilities. They analyze documentation to verify accuracy, completeness, and adherence to clinical guidelines. By working remotely, they use secure digital systems to access records, communicate with healthcare teams, and contribute to quality improvement initiatives from a home or off-site location.

What are the key skills and qualifications needed to thrive as a quality review nurse remote?

To thrive as a Quality Review Nurse Remote, you need a nursing degree (RN), active RN license, and strong clinical review and analytical skills. Familiarity with utilization management systems, electronic health records (EHRs), and quality assurance software is typically required. Attention to detail, effective communication, and self-motivation are essential soft skills for excelling in a remote environment. These skills ensure accurate quality assessments, regulatory compliance, and effective collaboration while working independently.

What are some common challenges faced by quality review nurses working remotely, and how can they be managed?

Quality Review Nurses working remotely often encounter challenges such as staying updated with rapidly changing healthcare regulations, maintaining effective communication with healthcare teams, and managing time efficiently while handling multiple case reviews. To address these challenges, it's helpful to establish a structured daily routine, leverage collaboration tools for regular check-ins with colleagues, and participate in ongoing training or webinars to stay current on policies. Proactive communication and strong organizational skills are key to excelling in this remote role.

What is the difference between Quality Review Nurse Remote vs Utilization Review Nurse Remote?

AspectQuality Review Nurse RemoteUtilization Review Nurse Remote
CertificationsRN license, possibly CCRN or CPHQRN license, often with UR or CCM certification
Work EnvironmentRemote, healthcare settings, insurance companiesRemote, insurance companies, healthcare organizations
Job FocusAssess quality of care, compliance, patient safetyEvaluate medical necessity, approve or deny services

Both roles are remote nursing positions within healthcare and insurance industries. Quality Review Nurses focus on assessing care quality and compliance, while Utilization Review Nurses primarily evaluate medical necessity for services. While they share certifications and work environments, their core responsibilities differ, making each role unique in healthcare quality and utilization management.

More about Quality Review Nurse Remote jobs

What cities are hiring for Quality Review Nurse Remote jobs?

Cities with the most Quality Review Nurse Remote job openings:

What are the most commonly searched types of Quality Review Nurse jobs?

The most popular types of Quality Review Nurse jobs are:

What states have the most Quality Review Nurse Remote jobs?

States with the most job openings for Quality Review Nurse Remote jobs include:

What job categories do people searching Quality Review Nurse Remote jobs look for?

The top searched job categories for Quality Review Nurse Remote jobs are:

Quality Review Nurse Remote jobs near you
Infographic showing various Quality Review Nurse Remote job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 4% Contract, and 1% Nights. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $90,275 per year, or $43.4 per hour.

Utilization Management Specialist

System One

Baltimore, MD • Remote

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 28 days ago

Job description

Utilization Management Specialist (UM / Utilization Review Nurse) — Remote

Location: 100% Remote (U.S.) — Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension) Schedule: Mon–Fri, 8:00am–5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am–9:00am ET Pay (W2): USD 51.00/H

Job overview

In this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You’ll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.

What you’ll do

  • Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).
  • Make medical necessity / appropriateness determinations and support prior authorizations.
  • Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines).
  • Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines.
  • Research diagnoses/treatments and high-cost services; summarize findings and escalate complex cases to Medical Directors as needed.
  • Collaborate with internal partners and providers to support benefit application and appropriate levels/settings of care.
  • Maintain accurate documentation and protect PHI while managing a busy caseload.

Required qualifications

  • Active RN or LPN license (RN preferred) — Maryland compact/eligibility required
  • 5+ years clinical nursing experience
  • 2+ years care management / utilization management experience
  • MCG experience (required)
  • Experience supporting Commercial/FEP/Medicare lines of business and applying medical policy/regulatory standards
  • Strong critical thinking, written communication, and ability to work independently in a remote setting
  • Comfortable with web-based tools + Microsoft Office (Word/Excel/PowerPoint)
  • Guiding Care and FACETS (required)

Nice to have

  • Critical Care or ER clinical background
  • Experience with LCD/NCD, Medicare guidelines, ASAM, or other authorization criteria sets

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1

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About System One

Sourced by ZipRecruiter

System One helps employers get work done more efficiently and economically without compromising quality. Over our 35+ year history, we've helped connect thousands of talented people with innovative companies. The excitement of a perfect fit motivates us every single day.

Industry

Business consulting services and recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Pittsburgh, PA, US

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