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Remote Rn Utilization Review Nurse Jobs in Boston, MA

VITRA Health

Nurse Compliance Manager

Boston, MA · Remote

$140K - $150K/yr

... audit reviews to strengthen regulatory adherence, audit readiness, and quality performance. You ... This role requires a strong clinical background (RN required), deep knowledge of healthcare ...

Carease Health - MA

Nurse Practitioner

Reading, MA · On-site +1

$23K - $25K/yr

Utilize Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Collaborative Care ... care and Documentation review * Excellent communication, collaboration, and teamwork skills

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All JobsRn Utilization Review Nurse JobsRemote Rn Utilization Review Nurse JobsRemote Rn Utilization Review Nurse Jobs in Boston, MA

Remote Rn Utilization Review Nurse information

See Boston, MA salary details

$23

$45

$74

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

As of Aug 9, 2026, the average hourly pay for remote rn utilization review nurse in Boston, MA is $45.94, according to ZipRecruiter salary data. Most workers in this role earn between $36.30 and $52.74 per hour, depending on experience, location, and employer.

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 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 are the most commonly searched types of Rn Utilization Review Nurse jobs in Boston, MA? The most popular types of Rn Utilization Review Nurse jobs in Boston, MA are:
What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Boston, MA? For Remote Rn Utilization Review Nurse jobs in Boston, MA, the most frequently searched job titles are:
What job categories do people searching Remote Rn Utilization Review Nurse jobs in Boston, MA look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs in Boston, MA are:
What cities near Boston, MA are hiring for Remote Rn Utilization Review Nurse jobs? Cities near Boston, MA with the most Remote Rn Utilization Review Nurse job openings:
Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in Boston, MA as of August 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 100% Remote job distribution, with an average salary of $95,545 per year, or $45.9 per hour.

Group Health Operations Manager

Dane Street, LLC

Boston, MA • On-site, Remote

$75K - $93K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 7 days ago

Job description

100% REMOTE
JOB SUMMARY
Oversee and ensure the overall profitability of the regional operations center. This includes but is not limited to reaching and exceeding financial & referral goals, properly managing staffing efficiencies throughout the team, managing performance expectations & improvements for existing staff. Present management with regular reporting on any topic requested by the management team.
Dane Street's success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.
MAJOR DUTIES & RESPONSIBILITIES
Driving Revenue Growth
  • The Operations Manager drives revenue growth by delivering excellent Customer service.
    • This includes meeting scheduling best practices and turnaround time requirements.
    • Ensuring the timely delivery of high quality reports.
  • Managing client inquiries in a timely manner.

Optimizing Physician cost
  • Ensuring that client invoices adhere to the agreed upon fee schedule.
  • Overseeing the proper selection of physicians.
  • Specifically ensuring that the team selects the most appropriate physician based on the claimant's location, the required specialty, and the most appropriately priced physician based on the client's fee schedule.
  • Building relationships with key physicians to ensure panel retention.

Manage Staff Performance and capacity
  • Monitor key performance metrics of individual Customer Service Representatives (CSR) and Quality Assurance (QA) Specialists.
  • Ensure the team meets or exceeds 85% of output goals for scheduling and Quality Assurance targets.
  • Responsible for hiring new staff members based on increased referral volume and/or the addition of new clients.
  • Conducts performance evaluations that are timely and constructive.
  • Handles discipline and termination of employees as needed and in accordance with company policy.
  • Responsible for the overall production, performance, and quality of the assigned region.
    • Plans and organizes daily activities related to production and operations.
    • Measures productivity by analyzing performance data, financial data, and activity reports.
    • Coordinates with other support departments such as human resources, finance, and IT and BA to ensure successful production operations.
    • Determines labor needs to meet production goals.

Requirements
EDUCATION/CREDENTIALS:
  • An Associate's Degree or Bachelor's Degree is preferred.
  • RN / LPN License is required.

JOB RELEVANT EXPERIENCE:
  • Business experience in a healthcare and/or insurance setting is preferred.
  • Business experience in a Worker's Compensation and/or Auto insurance setting is preferred.
  • Utilization Review experience is required.

JOB RELATED SKILLS/COMPETENCIES:
  • Present exceptional communication skills with a clear understanding of company business lines.
  • The ability to apply critical thinking, manage time efficiently and meet specific deadlines. Computer literacy and typing skills are essential.

WORK FROM HOME TECHNICAL REQUIREMENTS:
  • Supply and support their own internet services.
  • Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.
Our Commitment:
We are committed to providing fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees.
Compensation Range: $75,000 - $93,750 USD
Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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