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Remote Rn Utilization Review Nurse Jobs in Georgia

Elevance Health

Med Mgmt Nurse (contract)

Decatur, GA · Remote

... utilization review, or managed care experience; or any combination of education and experience ... Current active, valid and unrestricted RN license and/or certification to practice as a health ...

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Remote Rn Utilization Review Nurse information

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 are the key skills and qualifications needed to thrive as a Remote RN Utilization Review Nurse?

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 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.

What are the most commonly searched types of Rn Utilization Review Nurse jobs in Georgia?

The most popular types of Rn Utilization Review Nurse jobs in Georgia are:

What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Georgia?

For Remote Rn Utilization Review Nurse jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Remote Rn Utilization Review Nurse jobs in Georgia look for?

The top searched job categories for Remote Rn Utilization Review Nurse jobs in Georgia are:

Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in Georgia as of August 2026, with employment types broken down into 84% Full Time, 5% Part Time, and 11% Contract. Highlights an 100% Remote job distribution.

Tele-Triage Registered Nurse - RN

Starting Point Nursing Services

Atlanta, GA • On-site, Remote

$33 - $35/hr

Full-time

Re-posted yesterday

Job description

Our Company

Starting Point Nursing Services

Overview

Full Time Tele-Triage (Fully Remote) Registered Nurse Position:

*Must have compact state RN licensure from the state in which you currently reside

*Remote Triage & Home Health RN experience highly preferred

*Potential Start Date:  9/14/26

New Available FULL TIME Schedule:

* Tuesday, Wednesday, Thursday 2p-10p CST (3p-11p EST) & Friday 11a-7p CST (12p-8p EST) & Saturday 8a-4p CST (9a-5p EST)

This Registered Nurse provides On-Call and Triage for the assigned population in accordance with triage protocols. This position remotely develops/implements care plans for persons served in the area of responsibility. The Tele-Triage RN assesses health status, identifies problems and needs of person(s) served in their assigned caseload, develops nursing care plans in collaboration with operations RN's. You will complete chart reviews and monthly host home reviews and perform On-Bound calling to assigned populations/locations. This RN performs data analysis in multiple systems.

Responsibilities
  • Monitor assigned phone lines during service hours to ensure timely response for caller needs
  • Triage all symptom-based calls and give recommendations according to the approved triage protocol
  • Triage patients by assessing severity of symptoms and referral to appropriate setting or level of care
  • Document in real time all care related recommendations and ensure local operations are notified of triage supports and outcomes
  • Initiate contact with acute care setting to coordinate services for clients receiving care in the ED/Hospital and coordinate the discharge planning; Notify operations of triage recommendations
  • Coordinate any medication orders with the assigned pharmacy and update MAR/QuickMar for appropriate administration
  • Work assigned prior authorizations to ensure timely documentation and submit to assigned pharmacy for billing
  • Complete/conduct assessment and reassessment of persons served as assigned
  • Develop/update care plans and determine persons served needs and secure physicians orders as needed
  • Communicate with beneficiaries primarily phone, text, online (web) chat, or email
  • Ensure compliance with state/local/payer requirements through review of documentation
  • Provide coaching and education related to the health and well-being of persons served
  • Participate in performance improvement activities and maintain ongoing clinical knowledge through internal/external training programs
  • Document above actions in Nurse's Notes or Service Delivery Log
  • Maintain time sheet log for weekly submission for productivity management to assigned supervisor
  • Notify each practice, physician, and/or managed care client of all encounters with patients, parents, or managed care clients regardless of follow-up needs before office opening
  • Notify designated leadership of operational concerns
  • Actively participate in applicable meetings and committees as requested (e.g., IDT, HRC, Safety/Quality committee, and annual person served directed/active treatment plan meetings)
Qualifications
  • Degree/certification from an accredited school of nursing
  • Current licensure as a Registered Nurse (RN) in the state of practice, which is current and remains in good standing. Must have a compact state RN license.
  • Clinical experience in providing services and supports to individuals with intellectual and developmental disabilities, home health and Hospice patients or related disorders
  • Two year Home Health nursing experience
About our Line of BusinessStarting Point Nursing Services, an affiliate of BrightSpring Health Services, is staffed 100% by a team of remote registered nurses trained to support the post-acute continuum with clinical advice and interventions. Our 24/7 On-Call and Triage team responds to physician practices, home health agencies, intellectual disability providers, and assisted living providers. Our services are tailored to our partners, including remote physical/chart assessments, predictive care modeling, clinical programming interventions for high-risk populations, emergent care coordination, and case management. For more information, please visit www.startingpointnursing.com. Follow us on LinkedIn.Salary RangeUSD $33.00 - $35.00 / HourEmployment Type: FULL_TIME

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