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Remote Nicu Utilization Review Jobs (NOW HIRING)

Ascension

Registered Nurse Utilization Review

Austin, TX · Remote

$84K - $118K/yr

Remote Facility: Ascension Network Services Department: Utilization Management Schedule: Days l ... Review admissions and service requests within assigned unit for prospective, concurrent and ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Our commitment is to cultivate a place that provides intentional and exceptional care for our ... Utilization Review Specialist: Responsible for ensuring adherence to Mindful Health's utilization ...

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

And as the need for world-class mental health care continues to rise, our commitment is stronger ... This position is posted as remote; however, per company policy, candidates residing within a ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... We provide integrated, whole-person care through primary care, specialty care, behavioral health ...

Winston Medical Staffing

Be Seen First

Utilization Review Nurse

Newark, NJ · Remote

$38 - $40/hr

Position is 100% remote but will have to go to Newark, NJ to pick up equipment and short ... Evaluates care by problem solving, analyzing variances and participating in the quality improvement ...

Prime Healthcare

Utilization Review Coordinator

Ontario, CA · On-site +1

$30 - $40.50/hr

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime ... Additionally, this position entails working closely with the Corporate/Facility/Remote UR/CM teams ...

New

The Meadows

Utilization Review Coordinator

Phoenix, AZ · On-site +1

Meadows Behavioral Healthcare offer a range of specialized programs including residential ... As the Utilization Review Coordinator, you will develop and implement systems for authorizations ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... We provide integrated, whole-person care through primary care, specialty care, behavioral health ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... We provide integrated, whole-person care through primary care, specialty care, behavioral health ...

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Remote Nicu Utilization Review information

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How much do remote nicu utilization review jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for remote nicu utilization review 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 is the difference between Remote Nicu Utilization Review vs Remote Pediatric Utilization Review?

AspectRemote Nicu Utilization ReviewRemote Pediatric Utilization Review
CredentialsRN, NICU experience, utilization review certificationRN, pediatric experience, utilization review certification
Work EnvironmentHome-based, healthcare facilities, insurance companiesHome-based, healthcare facilities, insurance companies
Industry UsageHospitals, insurance, healthcare managementHospitals, insurance, healthcare management
Search IntentCompare roles, job requirements, salary, responsibilitiesCompare 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 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 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, and why are they important?

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.
More about Remote Nicu Utilization Review jobs
What cities are hiring for Remote Nicu Utilization Review jobs? Cities with the most Remote Nicu Utilization Review job openings:
What are the most commonly searched types of Nicu Utilization Review jobs? The most popular types of Nicu Utilization Review jobs are:
What states have the most Remote Nicu Utilization Review jobs? States with the most job openings for Remote Nicu Utilization Review jobs include:
What job categories do people searching Remote Nicu Utilization Review jobs look for? The top searched job categories for Remote Nicu Utilization Review jobs are:
Remote Nicu Utilization Review jobs near you
Infographic showing various Remote Nicu Utilization Review job openings in the United States as of June 2026, with employment types broken down into 86% Full Time, 9% Part Time, and 5% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse - Remote

Utilization Review Nurse - Remote

Martin's Point Health Care

Portland, ME • On-site, Remote

Full-time

Posted 17 days ago

Martin’s Point Health Care rating

7.4

Company rating: 7.4 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Job description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
The Utilization Review Nurse works as is responsible for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for inpatient/ outpatient authorizations. This position receives and reviews prior authorization requests for specific inpatient and outpatient medical services, notification of emergent hospital admissions, completes inpatient concurrent review, establishes discharge plans, coordinates transitions of care to lower/higher levels of care, makes referrals for care management programs, and performs medical necessity reviews for retrospective authorization requests as well as claims disputes.
The Utilization Review Nurse will use appropriate governmental policies as well as specified clinical guidelines/ criteria to guide medical necessity reviews and will use effective relationship management, coordination of services, resource management, education, patient advocacy and related interventions to ensure members receive the appropriate level of care, prevent or reduce hospital admissions where appropriate.
Job Description
Key Outcomes:
  • Review prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed for additional expertise and review.
  • Utilize evidenced-based criteria, governmental policies, and internal guidelines for medical necessity reviews.
  • Manage the review of medical claims disputes, records, and authorizations for billing, coding, and other compliance or reimbursement related issues
  • Collaborates with other members of the team, the MPHC Medical Directors, healthcare providers, and members to promote effective utilization of resources. This collaboration includes timely communications with in and out of network hospitals, post-acute care facilities, other providers, and internal departments to authorize services, establish discharge plans, assist to coordinate effective, efficient transitions of care.
  • Coordinates referrals to Care Management, as appropriate.
  • Manages health care within the benefits structures per line of business and performs functions within compliance, contractual and accreditation regulations, e.g. Department of Defense, Centers for Medicaid and Medicare, NCQA, Employer contracts and state insurance regulations, as applicable. Maintains knowledge of applicable regulatory guidelines.
  • Completes all documentation of reviews and decisions, in appropriate systems, according to process/ compliance requirements and within timeliness standards.
  • Participates as a member of an interdisciplinary team in the Health Management Department
  • May be responsible for maintaining a caseload for concurrent cases/ assisting in caseload coverage for the team
  • Establishes and maintains strong professional relationships with community providers.
  • Acts as a liaison to ensure the member is receiving the appropriate level of care at the appropriate place and time
  • Mentors new staff as assigned.
  • Meets or exceeds department quality audit scores.
  • Meets or exceeds department productivity.
  • Assists in creation and updating of department policies and procedures.
  • Participates in quality initiatives, committees, work groups, projects, and process improvements that reinforce best practice medical management programming and offerings.
  • Participates in the review and analysis of population data and metrics to inform development of programs and improved health outcomes.
  • Demonstrates flexibility and agility in working in a fast-paced, team-oriented environment, able to multi-task from one case type to another.
  • Assumes extra duties as assigned based on business needs, including weekend rotations

Education/Experience:
  • 3+ years of clinical nursing experience as an RN, preferably in a hospital setting
  • 2+ years of utilization management experience in a health plan UM department

Required License(s) and/or Certification(s):
  • Compact RN License
  • Certification in managed care nursing or care management desired (CMCN or CCM)
  • Coding/CPC desired

Skills/Knowledge/Competencies (Behaviors):
  • Proficiency in conducting prospective, concurrent, and retrospective reviews using standardized criteria and guidelines like MCG
  • Ability to review and interpret medical records, treatment plans, and clinical documentation, with a keen eye for detail and compliance with healthcare standards
  • Thorough understanding of healthcare policies, insurance guidelines, and regulatory standards (e.g., Medicare, NCQA, TRICARE)
  • Familiarity with coding systems like ICD-10 and CPT
  • Technical savvy and ability to navigate multiple systems and screens while working cases
    Demonstrates an understanding of and alignment with Martin's Point Values.
  • Maintains current licensure and practices within scope of license for current state of residence.
  • Maintains knowledge of Scope of Nursing Practice in states where licensed.
  • Maintains contemporary knowledge of evidence-based guidelines and applies them consistently and appropriately.
  • Ability to analyze data metrics, outcomes, and trends.
  • Excellent interpersonal, verbal, and written communication skills.
  • Critical thinking: can identify root causes and understands coordination of medical and clinical information.
  • Ability to prioritize time and tasks efficiently and effectively.
  • Ability to manage multiple demands.
  • Ability to function independently.
  • Computer proficiency in Microsoft Office products including Word, Excel, and Outlook.

This position is not eligible for immigration sponsorship.
We are an equal opportunity/affirmative action employer.
Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org
Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org

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