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Remote Rn Utilization Review Nurse Jobs in Maine

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 ...

InterMed

Clinical Care Rep RN

South Portland, ME · On-site +1

$33.34 - $48.31/hr

Unencumbered active registered nurse or LPN licensure in state of Maine * Previous experience in a ... For further information, please review the Know Your Rights notice from the Department of Labor.

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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 Aug 21, 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.

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 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 August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 13% Part Time, 3% Temporary, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $85,150 per year, or $40.9 per hour.

RN, Clinical Document Spec

University of Rochester

On-site, Remote

$81K - $109K/yr

Full-time

Posted 28 days ago

University Of Rochester rating

8.3

Company rating: 8.3 out of 10

Based on 186 frontline employees who took The Breakroom Quiz

126th of 620 rated colleges and universities

Job description

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.
Job Location (Full Address):
601 Elmwood Ave, Rochester, New York, United States of America, 14642
Opening:
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
500009 Utilization Management
Work Shift:
UR - Day (United States of America)
Range:
UR URCD 215
Compensation Range:
$81,307.00 - $109,761.00
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Responsibilities:
Facilitates clinical documentation improvement through concurrent and retrospective interaction with physicians and members of the healthcare team. This interaction supports the clinical severity of the inpatient admission, quality documentation standards that align with federal and state regulations and assists with maximizing revenue.
Essential Functions:
  • Recognizes gaps and facilitates modifications in clinical documentation that support the accuracy of medical conditions for inpatient encounters. Recognizes documentation opportunities with the assistance of computer software. Conducts clinical documentation improvement efforts through query processes.
  • Provides oversight of EPARC, including UM and unbilled work queues. Communicates with individual physicians and medical team, providing guidance and clarification around principle diagnoses, complicating conditions, and diagnoses being treated to ensure complete and accurate documentation in the medical record.
  • Presents overall findings to key stakeholders, including leadership and peers. Provides education to peers and healthcare team members on documentation improvement, reimbursement opportunities, and overall performance.
  • Demonstrates knowledge of trends in clinical diagnoses that result in payer denials. Ensures the validity of data for reporting and measuring physician and hospital outcomes through software and data analysis. Audits clinical documentation to confirm points of clarification have been entered in the medical record.
  • Meets established productivity expectations of the CDI program. Maintains knowledge of hospital clinical practice guidelines to support the most thorough review of the medical record.
  • Other duties as assigned.

Minimum Education & Experience:
  • Bachelor's degree in Nursing (BSN) and 5 years of inpatient clinical experience, knowledge of complex disease processes required OR
  • Bachelor's, Master's or Doctorate degree in a relevant clinical discipline: Prepared Physician Assistant (PA) or Nurse Practitioner (NP) or Bachelor of Medicine, Bachelor of Surgery (MBBS) or Doctor of Medicine/Osteopathic Medicine (MD/DO) and 5 years inpatient clinical experience, knowledge of complex disease processes required.
  • Or equivalent combination of education and experience.
  • Prior experience with EPARC, eRecord, HDM, and SharePoint preferred.

Licenses and Certifications:
  • Registered Nurse License, current in NYS upon hire required or NP - Nurse Practitioner license, current in NYS upon hire required or PA - Physician Assistant license current in NYS upon hire required or MD - Doctor of Medicine - MD License current in NYS upon hire required or DO - Doctor of Osteopathic Medicine current DO License in NYS upon hire required AND Clinical Documentation Specialist (CDS) upon hire preferred or CDIP - Clinical Documentation Improvement Professional upon hire preferred

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University's Mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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