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Remote Anthem Utilization Review Nurse Jobs (NOW HIRING)

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 ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

iMPROve Health

Contingent UR/LTSS Registered Nurse

... Utilization Review / Long-Term Services & Supports (UR/LTSS) Review Nurse . This fully remote ... position supports Michigan Medicaid programs by conducting Nursing Facility Level of Care (LOC ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

Description Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

Astrana Health

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

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Showing results 41-60

All JobsAnthem Utilization Review Nurse JobsRemote Anthem Utilization Review Nurse Jobs

Remote Anthem Utilization Review Nurse information

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$21

$42

$68

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

As of Aug 15, 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 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UM Review Nurse

Astrana Health, Inc.

Remote

$34 - $47/hr

Other

This job post has expired today. Applications are no longer accepted.

Job description

UM Review Nurse
Department: HS - UM
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Phillip Vasquez
Compensation: $34.00 - $47.00 / hour
Description
Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans.
This position requires open availability between Monday through Sunday, 8 A - 8 P. You would be scheduled for 5 shifts per week. This is a remote position for CA-licensed nurses. Candidates must live in California.
We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting.
Our Values:
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team
What You'll Do
  • Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
  • Refer cases to Medical Directors as needed/appropriate
  • Maintain knowledge of state and federal regulations and accreditation standards
  • Comply with internal policies and procedures
  • Perform any other job duties as requested
Qualifications
  • Active and unrestricted LVN license in CA.
  • At least 1 years of outpatient UM experience
  • Experience with Microsoft applications such as Word, Excel, and Outlook
You'll be Great for this Role If:
  • At least two (2) years of health plan, IPA or MSO experience
  • Strong interpersonal skills
  • Ability to collaborate with co-workers, senior leadership, and other management
  • Experience educating and training staff
Environmental Job Requirements and Working Conditions
  • This is a remote position. Our office is located at 1600 Corporate Center Drive in Monterey Park, CA. Candidates who live within a 30 mile radius of the office may be expected to work hybrid.
  • Typical business hours are Monday - Friday from 8:30 AM to 5 PM, however, this position requires open availability between 8 AM - 8 PM PST, M-Su. Your schedule will be compromised of 5 shifts per week. Nurses rotate weekend and holiday coverage. Overtime is required in this position.
  • The national target pay range for this role is $34.00 - $47.00 per hour. Actual compensation will be based on job level, geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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