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Remote Anthem Utilization Review Nurse Jobs (NOW HIRING)

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ...

CoxHealth

Registered Nurse - Utilization Review

Remote Missouri: 1423 North Jefferson Avenue, Springfield, Missouri, United States of America ... Benefits | CoxHealth The Utilization Review Nurse RN collaborates with the physician and members of ...

New

Dane Street

PRN Utilization Review Nurse Reviewer

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring ... Apple equipment and a media stipend are provided for remote workspace. ABOUT DANE STREET: A fast ...

Personify Health

Utilization Review Nurse - RN

$30 - $38/hr

Current, unrestricted RN license in the United States or a U.S. territory (compact license accepted ... Utilization review/utilization management experience preferred Technical Skills: * Proficiency with ...

Astrana Health, Inc.

UM Review Nurse

$34 - $47/hr

... Utilization Review Nurse to assist our Health Services Department. In this position, you will ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

CommonSpirit Health

Utilization Review RN

The Utilization Review RN is responsible for the review of medical records for appropriate ... This position is open to remote/out of state candidates residing in only these states: Alabama ...

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Remote Anthem Utilization Review Nurse information

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

As of Aug 7, 2026, the average hourly pay for remote anthem 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 Remote Anthem Utilization Review Nurse?

To thrive as a Remote Anthem Utilization Review Nurse, you need a valid RN license, strong clinical judgment, and experience in utilization management or case review. Familiarity with medical management software, electronic health records, and accreditation standards such as NCQA or URAC is typically required. Excellent communication, critical thinking, and time management skills are essential for effective collaboration and decision-making in a virtual environment. These competencies ensure accurate reviews, regulatory compliance, and efficient care coordination for Anthem members.

What is a Remote Anthem Utilization Review Nurse?

A Remote Anthem Utilization Review Nurse is a registered nurse who works from home to review medical cases and claims for Anthem, a major health insurance company. Their primary role is to assess whether the healthcare services provided to members are medically necessary and align with Anthem’s policies and guidelines. They analyze patient records, collaborate with healthcare providers, and ensure that the care given is appropriate and cost-effective. By working remotely, these nurses use secure digital platforms to perform their duties, offering flexibility while maintaining high standards of care review.

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

AspectRemote Anthem Utilization Review NurseRemote Case Manager
CredentialsRN license, certifications in utilization reviewRN or social work license, case management certification
Work EnvironmentHealthcare insurance, utilization review teamsHealthcare providers, insurance companies, patient advocacy
Employer & IndustryHealth insurance companies like Anthem, healthcare industry

Remote Anthem Utilization Review Nurses focus on reviewing medical necessity and appropriateness of care for insurance claims, primarily within insurance companies. Remote Case Managers coordinate patient care, discharge planning, and resource management across healthcare settings. While both roles require healthcare knowledge and RN credentials, utilization review nurses specialize in insurance review processes, whereas case managers focus on patient care coordination.

What are some common challenges faced by Remote Anthem Utilization Review Nurses, and how can they be managed?

Remote Anthem Utilization Review Nurses often encounter challenges such as balancing high caseloads, navigating complex insurance guidelines, and maintaining effective communication with healthcare providers and patients from a distance. Staying organized and up-to-date with payer policies can help manage workload efficiently. Using secure communication platforms and participating in regular virtual team meetings also aids in building collaboration and ensuring accurate, timely reviews. Proactively seeking clarification on ambiguous cases and utilizing available support resources can further help overcome day-to-day obstacles in this remote role.
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Remote Anthem Utilization Review Nurse jobs near you
Infographic showing various Remote Anthem Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% 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.

Utilization Review Nurse-Remote-Contract

HireOps Staffing, LLC

Dallas, TX • Remote

$40/hr

Full-time

Posted yesterday

New

Job description

$40/hour - Contract for 6 months
Must reside in TX

Full time remote
Candidates must be based in TX.
RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
pay rate is $40/hour
This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers and facilities.
Registered Nurse (RN) with valid, current, unrestricted license in the state of operations.
* 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company.
* Knowledge of medical terminology and procedures.
* Verbal and written communication skills.
PREFERRED JOB REQUIREMENTS:
* Utilization management experience
* MCG or InterQual experience