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Remote Rn Utilization Review Nurse Jobs in Decatur, GA

CVS Health

Case Manager, Registered Nurse

Atlanta, GA · Remote

$54.10K - $155.54K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

CVS Health

Case Manager, Registered Nurse

Atlanta, GA · Remote

$54.10K - $155.54K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

CGI Inc.

Remote Clinical Nurse Auditor

Atlanta, GA · On-site +1

In this role, you will be responsible for reviewing medical records to determine the medical ... Registered Nurse (RN) with active, unrestricted licensure in the state of residence. Clinical ...

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Remote Rn Utilization Review Nurse information

See Decatur, GA salary details

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$41

$67

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

As of Jun 1, 2026, the average hourly pay for remote rn utilization review nurse in Decatur, GA is $41.28, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.40 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.

What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Decatur, GA? For Remote Rn Utilization Review Nurse jobs in Decatur, GA, the most frequently searched job titles are:
What job categories do people searching Remote Rn Utilization Review Nurse jobs in Decatur, GA look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Remote Rn Utilization Review Nurse jobs? Cities near Decatur, GA with the most Remote Rn Utilization Review Nurse job openings:
Remote Rn Utilization Review Nurse jobs near you

RN - Utilization Management

Piedmont Healthcare Inc.

Atlanta, GA • On-site, Remote

Full-time

Posted 4 days ago

Piedmont Healthcare rating

7.0

Company rating: 7.0 out of 10

Based on 449 frontline employees who took The Breakroom Quiz

400th of 864 rated healthcare providers

Job description

Overview
Experience the advantages of real career change
Join Piedmont to move your career in the right direction. Stay for the diverse teams you'll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You'll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.
Responsibilities
The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This roles monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensures that the patient's payer has the clinical information with which to authorize an acute hospital stay and the continued stay services to include covered days and associated services.
Qualifications
Education
  • Graduate of an accredited nursing school Required
  • Bachelor's Degree of Science in Nursing Preferred
  • Master's degree Preferred
Work Experience
  • 2 years of experience in an acute, post-acute or payer setting Required
  • 3 years of utilization review or care management experience Preferred
Licenses and Certifications
  • RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required

Business Unit : Company Name
Piedmont Healthcare Corporate

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