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Remote Rn Utilization Review Nurse Jobs (NOW HIRING)

Village Care

Utilization Review Nurse

Manhattan, NY · Remote

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - NY, NJ, or CT COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is ...

Pacer Group

RN - UTILIZATION REVIEW

Everett, WA · Remote

$65/hr

Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30) Shift Notes: Days (5×8 ...

Pacer Group

RN - UTILIZATION REVIEW

Everett, WA · Remote

$65/hr

Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30) Shift Notes: Days (5×8 ...

IntePros

Utilization Review Nurse

Manhattan, NY · Remote

$35 - $45/hr

... Remote Utilization Review Nurse serves as a key clinical liaison, coordinating resources and ... Qualifications Graduate of an accredited professional nursing program (RN, LPN, or LVN). Minimum of ...

IntePros

Utilization Review Nurse

Phoenix, AZ · Remote

$35 - $40/hr

Base Pay Range $35.00/hr - $40.00/hr Location Fully Remote Position Summary The Utilization Review ... Current, active nursing license (RN, LPN, or LVN) in good standing with the Arizona Board of ...

Oscar Health

Utilization Review Nurse

Manhattan, NY · Remote

$35 - $45.94/hr

Work Location This is a remote position, open to candidates who reside in: Arizona; Florida ... RN licensure from the United States in [state], OR, active compact multistate unrestricted RN ...

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

As of Jun 5, 2026, the average hourly pay for remote rn 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 RN Utilization Review Nurse, and why are they important?

To thrive as a Remote RN Utilization Review Nurse, you need an active RN license, strong clinical knowledge, and experience in case management or utilization review. Proficiency with healthcare review software, electronic health records (EHRs), and familiarity with insurance guidelines or regulatory requirements is vital. Excellent communication, critical thinking, and time management skills distinguish top performers in remote settings. These skills enable nurses to make accurate, timely decisions about patient care while ensuring compliance and efficient resource utilization.

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

Remote RN Utilization Review Nurses often encounter challenges such as managing large caseloads, maintaining effective communication with interdisciplinary teams, and staying updated with ever-changing insurance guidelines. Balancing productivity expectations while ensuring thorough case reviews can be demanding. To address these challenges, nurses can utilize robust organizational tools, participate in ongoing training sessions, and leverage regular virtual meetings to stay connected with colleagues and supervisors, ensuring both efficiency and high-quality patient care.

What is a Remote RN Utilization Review Nurse?

A Remote RN Utilization Review Nurse is a registered nurse who evaluates medical records and healthcare services from a remote location to ensure that patients receive appropriate, necessary, and cost-effective care. They review treatment plans, check for compliance with insurance and healthcare guidelines, and often work with healthcare providers, insurance companies, and patients to coordinate care. This role typically involves assessing the medical necessity of procedures, authorizing services, and helping prevent unnecessary treatments or hospitalizations.

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

AspectRemote Rn Utilization Review NurseRemote Rn Case Manager
CertificationsRN license, possibly UR or CCM certificationRN license, CCM or other case management certification
Work EnvironmentReviewing medical records, insurance guidelines, and authorizationsCoordinating patient care, discharge planning, and resource management
Employer & Industry UsageHealth insurance companies, third-party administratorsHospitals, health plans, healthcare providers

Remote Rn Utilization Review Nurses primarily evaluate medical necessity for insurance approvals, focusing on documentation and guidelines. In contrast, Remote Rn Case Managers coordinate patient care, discharge planning, and resource allocation. Both roles require RN licensure and related certifications but differ in daily tasks and work focus.

More about Remote Rn Utilization Review Nurse jobs
What cities are hiring for Remote Rn Utilization Review Nurse jobs? Cities with the most Remote Rn Utilization Review Nurse job openings:
What are the most commonly searched types of Rn Utilization Review Nurse jobs? The most popular types of Rn Utilization Review Nurse jobs are:
What states have the most Remote Rn Utilization Review Nurse jobs? States with the most job openings for Remote Rn Utilization Review Nurse jobs include:
What job categories do people searching Remote Rn Utilization Review Nurse jobs look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs are:
Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in the United States as of May 2026, with employment types broken down into 1% Locum Tenens, 64% Full Time, 9% Part Time, and 26% Contract. Highlights an 98% Physical, and 2% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse

Utilization Review Nurse

Village Care

Manhattan, NY • Remote

$95K - $105K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

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

Job description

RN- Utilization Review Nurse

Inpatient

*Hybrid*

Must reside within the New York Tri-State Area - NY, NJ, or CT


COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE!


VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services. Some of your daily activities will include:

  • Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria - prospective, concurrent and retrospective review.
  • Frequently collaborates and communicates with physician peer reviewers and medical directors in determining coverage of requested services.
  • Provide intervention and coordination to decrease delays and denials.
  • Maintains timely, complete and accurate documentation in compliance with VCMAX policies and procedures.
  • Support Quality and Performance Improvement Initiatives.
  • Timely follow-up on results of denial and internal appeal reviews.

We would like to speak to those who have a current unrestricted NYS RN license to practice professional nursing, URAC preferred. Seeking those who bring a BSN (advanced degree preferred), along with 2+ years of utilization review experience at a Managed Care Organization or Health Plan required. Working knowledge of Medicaid and/or Medicare regulations as well as coverage guidelines and benefit limitations. The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines will be vital to this role. Must have a minimum of 1 year long term support service experience. Inpatient experience required. MLTC and Hospital/SNF experience required.


Must reside within the New York Tri-State Area - NY, NJ, or CT.


There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you!

  • PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life & Disability, Commuter Benefits, Paid Family Leave, Additional Employee Discounts

VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.


VillageCare is an Equal Opportunity Employer.


Job Posted by ApplicantPro