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Remote Rn Utilization Review Nurse Jobs in Maine

Husson University

Remote Adjunct - FNP/PMHNP/AGACNP Nursing

ME · On-site +1

$112K - $142K/yr

Meet with the Program Director at the end of each semester to review course evaluations and provide ... Active unencumbered United States RN licensure. * Active unencumbered United States Advanced ...

University of Rochester

$81K - $109K/yr

Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management ... Maintains knowledge of hospital clinical practice guidelines to support the most thorough review of ...

University of Rochester

$81K - $109K/yr

Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management ... Maintains knowledge of hospital clinical practice guidelines to support the most thorough review of ...

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Remote Rn Utilization Review Nurse information

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

As of Jul 27, 2026, the average hourly pay for remote rn utilization review nurse in Maine is $40.94, according to ZipRecruiter salary data. Most workers in this role earn between $32.36 and $47.02 per hour, depending on experience, location, and employer.

How to make an extra 2000 a month as a nurse?

A remote RN utilization review nurse can increase income by taking on additional shifts, working overtime, or pursuing specialized certifications such as CCM or CPHQ to qualify for higher-paying roles. Developing skills in case management, telehealth, or documentation can also open opportunities for freelance or consulting work to earn extra income.

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.

How to get into utilization review as a nurse?

To become a utilization review nurse, you typically need to be a registered nurse (RN) with clinical experience and obtain knowledge of insurance processes and healthcare regulations. Many employers prefer candidates with certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Gaining experience in case management, medical records review, or insurance settings can improve your chances of entering utilization review roles.

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, 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.

How can I make $2000 a week working from home?

A Remote Rn Utilization Review Nurse can potentially earn $2000 or more weekly by working full-time hours, often requiring specialized nursing experience, certification, and strong clinical assessment skills. Increasing income may involve taking on additional shifts, working for multiple employers, or gaining advanced certifications to qualify for higher-paying roles. Flexibility and efficiency with electronic health record tools can also enhance earning potential.

How to become a remote nurse reviewer?

To become a remote RN utilization review nurse, candidates typically need an active nursing license, experience in case management or utilization review, and familiarity with healthcare software and medical records. Certification in case management or utilization review, such as the Certified Case Manager (CCM), can enhance job prospects. Strong communication skills and the ability to work independently are also important for remote roles.
What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Maine? For Remote Rn Utilization Review Nurse jobs in Maine, the most frequently searched job titles are:
What job categories do people searching Remote Rn Utilization Review Nurse jobs in Maine look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs in Maine are:
Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in Maine as of July 2026, with employment types broken down into 2% As Needed, 58% Full Time, 19% Part Time, and 21% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $85,150 per year, or $40.9 per hour.
*Registered Nurse Centralized Services - Remote after onsite training in Portland

*Registered Nurse Centralized Services - Remote after onsite training in Portland

Martin's Point Health Care

Portland, ME • On-site, Remote

Full-time

Posted 4 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 Central RN serves as a vital member of the centrally managed nursing team at Martin's Point Healthcare providing flexible, system-wide support across key functions including clinical triage, inbox management and care coordination. This role partners closely with all members of the care team to promote seamless care coordination and drive improved health outcomes for patients. The central RN must demonstrate adaptability and clinical expertise with flexibility to shift based on real-time demand and operational priorities.
Job Description
PRIMARY DUTIES AND RESPONSIBILITIES
Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.
  • Triages telephone calls applying standard protocols for patient care and recommendations dispositions
  • Evaluates patient symptoms, medical history and vital signs to triage patients in accordance with established guidelines and protocols to guide clinical decision making
  • Provides remote patient care, documentation and communication to patients and providers
  • Supports pre-visit planning and care coordination through summarizing patient needs and gaps for the visit, and updating the EMR as appropriate to include reconciliation of medications and ensuring appropriate orders are in place for the patient
  • Ensures that the provider has all the necessary clinical information about the patient prior to the visit, including clinical quality gaps, accurate diagnosis coding, and screenings that need to be addressed during the visit
  • Ensures timely and appropriate response to patient inquiries, test results, medication refills and other health related concerns communicated by the patient
  • Offers guidance and information to patients regarding their health concerns, treatment plans and self-care strategies through written and verbal communication
  • Maintains detailed and accurate records of all communications and actions taken in response to patient messages, ensuring compliance with best practices and regulatory requirements
  • Ensures accurate and timely documentation in the EMR, including scanning, per best practice guidelines and workflowsCoordinating care and services between providers and organizations to ensure that patient needs and preferences are met.
  • Promoting effective utilization of resources by facilitating and optimizing patient/member benefits.
  • Utilizing evidence-based guidelines and best practice care standards in clinical decision making and care management processes and interventions.
  • Educating patient/member and families to make informed personal health care decisions.
  • Meeting criteria for post-discharge outreach per organizational guidelines to support an effective intervention that results in reduction in readmission rates and integrity of health information during the transitional period.

POSITION QUALIFICATIONS
There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.
Education
  • Associate degree in Nursing
  • Bachelor's in nursing preferred

Licensure/certification
  • Current, unrestricted state Registered Nurse licensure
  • BLS required

Experience
  • 3+ years' experience in a clinical environment, preferably in a primary care setting
  • 5+ years' experience in a clinical environment, preferably in a primary care setting preferred
  • Telephone triage experience preferred

Knowledge
  • Knowledge of healthcare operations, especially in a primary care setting
  • Knowledge of quality measures and how to improve patient outcomes through quality gap closure
  • Understanding or interest in expanding knowledge of clinical quality measures (HEDIS) and coding concepts (CPT, ICD10, and HCC) preferred
  • Understanding of EHR documentation and quality reporting preferred

Skills
  • Strong critical thinking, problem-solving, and project management skills
  • Exceptional organizational, written and verbal communication, and attention to detail skills
  • Computer proficiency in Microsoft Office software
  • Proficient in working within an electronic medical record (EMR)

Abilities
  • Demonstrates an understanding of and alignment with Martin's Point Values
  • Ability to follow clinical protocols and standard workflows
  • Maintains patient confidentiality

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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