The Utilization Management Nurse performs medical necessity and benefit review requests in ... Collaborates with healthcare partners to ensure timely review of services and care. * Provides ...
Quick apply
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Collaborates with healthcare partners to ensure timely review of services and care. * Provides ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
... are partners to ensure timely review of services and care. • Provides referrals to Case ... in Utilization Review process including benefit interpretation, contract language, medical and ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
... are partners to ensure timely review of services and care. • Provides referrals to Case ... in Utilization Review process including benefit interpretation, contract language, medical and ...
Clinical Educator
Durham, NC · Remote
$70K - $80K/yr
Participate in scheduled customer meetings/conference calls to review in-servicing expectations and ... NICU/Nursery, Pediatrics, Labor & Delivery, Mother & Baby preferred * Must have valid driver ...
Quick apply
Clinical Educator
Durham, NC · Remote
$70K - $80K/yr
Participate in scheduled customer meetings/conference calls to review in-servicing expectations and ... NICU/Nursery, Pediatrics, Labor & Delivery, Mother & Baby preferred * Must have valid driver ...
Supervisor II Facility-Based Care Managers (Full-time Remote, North Carolina Based)
Morrisville, NC · On-site +1
Work with Human Resources and Unit Director to maintain and retain a highly qualified and well ... Knowledge of Utilization Management/Utilization review and other related areas * Knowledge of ...
Supervisor II Facility-Based Care Managers (Full-time Remote, North Carolina Based)
Morrisville, NC · On-site +1
Work with Human Resources and Unit Director to maintain and retain a highly qualified and well ... Knowledge of Utilization Management/Utilization review and other related areas * Knowledge of ...
Supervisor II Facility-Based Care Managers (Full-time Remote, North Carolina Based)
Morrisville, NC · On-site +1
Work with Human Resources and Unit Director to maintain and retain a highly qualified and well ... Knowledge of Utilization Management/Utilization review and other related areas * Knowledge of ...
Supervisor II Facility-Based Care Managers (Full-time Remote, North Carolina Based)
Morrisville, NC · On-site +1
Work with Human Resources and Unit Director to maintain and retain a highly qualified and well ... Knowledge of Utilization Management/Utilization review and other related areas * Knowledge of ...
Medical Director
Raleigh, NC · Remote
While this position allows remote work, the individual must reside within the state of North ... Minimum three (3) years of experience supporting policy interpretation, utilization review ...
Medical Director
Raleigh, NC · Remote
While this position allows remote work, the individual must reside within the state of North ... Minimum three (3) years of experience supporting policy interpretation, utilization review ...
Psychologist Reviewer
Durham, NC · On-site +1
$87K - $157K/yr
Why Join Us? * 100% remote flexibility * Meaningful work impacting care for youths with Autism * Be ... Interact with network practitioners to provide education on best practice models and utilization ...
Psychologist Reviewer
Durham, NC · On-site +1
$87K - $157K/yr
Why Join Us? * 100% remote flexibility * Meaningful work impacting care for youths with Autism * Be ... Interact with network practitioners to provide education on best practice models and utilization ...
Litigation Lead, Regulatory Healthcare Consulting
Chapel Hill, NC · Remote
$155K - $196K/yr
... review criteria: need analysis, financial feasibility, utilization projections, and service area ... Remote (USA-based; must be available during Eastern core hours 8:30 AM - 5:30 PM ET) * Travel ...
Litigation Lead, Regulatory Healthcare Consulting
Chapel Hill, NC · Remote
$155K - $196K/yr
... review criteria: need analysis, financial feasibility, utilization projections, and service area ... Remote (USA-based; must be available during Eastern core hours 8:30 AM - 5:30 PM ET) * Travel ...
Review cases with clinical complexity with direct supervisor and follow escalation protocols to ... utilization management to members with Behavioral Health and Physical Health conditions in a ...
Review cases with clinical complexity with direct supervisor and follow escalation protocols to ... utilization management to members with Behavioral Health and Physical Health conditions in a ...
... Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the ... Welcome patients into continuous care program(s) and review benefits and services included
... Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the ... Welcome patients into continuous care program(s) and review benefits and services included
... Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the ... Welcome patients into continuous care program(s) and review benefits and services included
Quick apply
... Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the ... Welcome patients into continuous care program(s) and review benefits and services included
Senior Engineer - Stormwater Review
Durham, NC · On-site +1
$79K - $122K/yr
... with benefits Remote Employment: Flexible/Hybrid Job Number: 26-05989 Department: Planning ... unit goals, as assigned; and ensures that all operations comply with applicable policies and ...
Senior Engineer - Stormwater Review
Durham, NC · On-site +1
$79K - $122K/yr
... with benefits Remote Employment: Flexible/Hybrid Job Number: 26-05989 Department: Planning ... unit goals, as assigned; and ensures that all operations comply with applicable policies and ...
Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...
Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...
Director, Remote Research Clinicians
Durham, NC · On-site +1
Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...
Director, Remote Research Clinicians
Durham, NC · On-site +1
Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...
Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...
Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...
Operating Unit manager - Data Centers
Raleigh, NC · Remote
$67K - $67K/yr
General Management Job Schedule: Full time Remote: No The Opportunity You will lead a GPQSS Segment ... The scope and depth of any background or security review will be determined based on the nature of ...
Operating Unit manager - Data Centers
Raleigh, NC · Remote
$67K - $67K/yr
General Management Job Schedule: Full time Remote: No The Opportunity You will lead a GPQSS Segment ... The scope and depth of any background or security review will be determined based on the nature of ...
Healthcare Support Representative -- Independent Contractor Location: Remote (US-Based) Make a ... Review basic technology requirements Hours * Choose your own schedule by self-scheduling 30-minute ...
Healthcare Support Representative -- Independent Contractor Location: Remote (US-Based) Make a ... Review basic technology requirements Hours * Choose your own schedule by self-scheduling 30-minute ...
Healthcare Support Representative -- Independent Contractor Location: Remote (US-Based) Make a ... Review basic technology requirements Hours * Choose your own schedule by self-scheduling 30-minute ...
Healthcare Support Representative -- Independent Contractor Location: Remote (US-Based) Make a ... Review basic technology requirements Hours * Choose your own schedule by self-scheduling 30-minute ...
Healthcare Support Representative -- Independent Contractor Location: Remote (US-Based) Make a ... Review basic technology requirements Hours * Choose your own schedule by self-scheduling 30-minute ...
Healthcare Support Representative -- Independent Contractor Location: Remote (US-Based) Make a ... Review basic technology requirements Hours * Choose your own schedule by self-scheduling 30-minute ...
Healthcare Support Representative -- Independent Contractor Location: Remote (US-Based) Make a ... Review basic technology requirements Hours * Choose your own schedule by self-scheduling 30-minute ...
Healthcare Support Representative -- Independent Contractor Location: Remote (US-Based) Make a ... Review basic technology requirements Hours * Choose your own schedule by self-scheduling 30-minute ...
Remote Nicu Utilization Review information
See Raleigh, NC salary details
$20.80 - $25
2% of jobs
$25 - $29.21
9% of jobs
$32.09 is the 25th percentile. Wages below this are outliers.
$29.21 - $33.42
21% of jobs
The median wage is $36.82 / hr.
$33.42 - $37.62
23% of jobs
$37.62 - $41.83
13% of jobs
$45.10 is the 75th percentile. Wages above this are outliers.
$41.83 - $46.03
10% of jobs
$46.03 - $50.24
8% of jobs
$50.24 - $54.45
5% of jobs
$54.45 - $58.65
5% of jobs
$58.65 - $62.86
2% of jobs
$62.86 - $67.06
2% of jobs
$20
$41
$67
How much do remote nicu utilization review jobs pay per hour?
As of Sep 7, 2026, the average hourly pay for remote nicu utilization review in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.
What is a remote NICU utilization review nurse?
A Remote NICU Utilization Review nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of care provided to newborns in Neonatal Intensive Care Units (NICU) from a remote location. They review patient records, treatment plans, and hospital stays to ensure that the care provided meets established clinical guidelines and insurance policies. This role helps optimize patient outcomes, control healthcare costs, and facilitate communication between healthcare providers, insurers, and families. Working remotely, these nurses use secure digital platforms to access medical records and collaborate with medical teams.
What are the key skills and qualifications needed to thrive as a remote NICU utilization review nurse?
To excel as a Remote NICU Utilization Review Nurse, you need a valid RN license, strong clinical expertise in neonatal intensive care, and experience with utilization management practices. Familiarity with case management software, electronic health records (EHRs), and UR-specific platforms such as InterQual or MCG is essential. Outstanding critical thinking, attention to detail, and effective written and verbal communication set top performers apart. These skills ensure accurate assessments, regulatory compliance, and optimized patient outcomes while working remotely in a highly specialized healthcare environment.
What are some common challenges faced in a remote NICU utilization review role and how can they be managed?
In a remote NICU Utilization Review position, professionals often encounter challenges such as ensuring thorough communication with clinical teams, navigating different electronic health record (EHR) systems, and maintaining up-to-date knowledge of evolving NICU care standards. Successfully managing these challenges typically involves establishing clear communication channels with onsite staff, participating in regular virtual team meetings, and dedicating time for ongoing education and training. Proficiency in telehealth technologies and strong organizational skills are also essential for accurate documentation and timely case reviews.
What is the difference between Remote Nicu Utilization Review vs Remote Pediatric Utilization Review?
| Aspect | Remote Nicu Utilization Review | Remote Pediatric Utilization Review |
|---|---|---|
| Credentials | RN, NICU experience, utilization review certification | RN, pediatric experience, utilization review certification |
| Work Environment | Home-based, healthcare facilities, insurance companies | Home-based, healthcare facilities, insurance companies |
| Industry Usage | Hospitals, insurance, healthcare management | Hospitals, insurance, healthcare management |
| Search Intent | Compare roles, job requirements, salary, responsibilities | Compare roles, job requirements, salary, responsibilities |
Remote Nicu Utilization Review involves evaluating NICU patient cases to ensure appropriate care and resource use, requiring NICU experience. Remote Pediatric Utilization Review focuses on pediatric cases, requiring pediatric nursing background. Both roles involve reviewing medical necessity and optimizing healthcare resources remotely within the healthcare and insurance industries.
What are the most commonly searched types of Nicu Utilization Review jobs in Raleigh, NC?
The most popular types of Nicu Utilization Review jobs in Raleigh, NC are:
What are popular job titles related to Remote Nicu Utilization Review jobs in Raleigh, NC?
For Remote Nicu Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:
What cities near Raleigh, NC are hiring for Remote Nicu Utilization Review jobs?
Cities near Raleigh, NC with the most Remote Nicu Utilization Review job openings:
Full-time
Re-posted yesterday
Job description
About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
• Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
• Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
• Collaborates with healthcare partners to ensure timely review of services and care.
• Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
• Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
• Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
• Triages and prioritizes cases and other assigned duties to meet required turnaround times.
• Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
• Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
• Duties as assigned.
Essential Qualifications
• Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Must be able to work independently.
• Must be detail oriented and have strong organizational and time management skills.
• Adaptive to a high pace and changing environment- flexibility in assignment.
• Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
• Proficient in MCG and CMS criteria sets
• Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
• Working knowledge of URAC and NCQA.
• 2+ years’ experience in a UM team within managed care setting.
• 3+ years’ experience in clinical nurse setting preferred.
• TPA Experience preferred.
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
• Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
• Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
• Collaborates with healthcare partners to ensure timely review of services and care.
• Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
• Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
• Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
• Triages and prioritizes cases and other assigned duties to meet required turnaround times.
• Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
• Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
• Duties as assigned.
Essential Qualifications
• Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Must be able to work independently.
• Must be detail oriented and have strong organizational and time management skills.
• Adaptive to a high pace and changing environment- flexibility in assignment.
• Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
• Proficient in MCG and CMS criteria sets
• Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
• Working knowledge of URAC and NCQA.
• 2+ years’ experience in a UM team within managed care setting.
• 3+ years’ experience in clinical nurse setting preferred.
• TPA Experience preferred.
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About Brighton Health Plan Solutions
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