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Remote Rn Utilization Review Nurse Jobs in Decatur, GA

Elevance Health

Med Mgmt Nurse (contract)

Decatur, GA · Remote

... utilization review, or managed care experience; or any combination of education and experience, which would provide an equivalent background. * Current active, valid and unrestricted RN license and ...

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Remote Rn Utilization Review Nurse information

See Decatur, GA salary details

$20

$41

$67

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

As of Jul 11, 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.

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 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

Tele-Triage Licensed Practical Nurse- LPN - PCTC

Starting Point Nursing Services

Atlanta, GA • Remote

$21/hr

Full-time

Posted 19 days ago

Job description

Our Company

Starting Point Nursing Services

Overview

Full Time LPN PCTC Tele-Triage (Fully Remote) Position!

*Potential Start Date:  7/13/26

*New Openings: 1 FT positions available- Monday-Friday, 9a-5p CST (10a-6p EST)

This LPN 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 LPN assesses health status, identifies problems and needs of person(s) served in their assigned caseload, develops nursing care plans in collaboration with operations LPN's. You will complete chart reviews and monthly host home reviews and perform On-Bound calling to assigned populations/locations. This LPN 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 inteLPNal/exteLPNal 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 conceLPNs
  • 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
  • At least one year of nursing experience
  • Current licensure as a LPN (LPN) in the state of practice, which is current and remains in good standing. Must have an LPN compact license.
  • Clinical experience in providing services and supports to individuals with intellectual and developmental disabilities, home health and Hospice patients or related disorders
  • One-year of home health experience preferred
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 $21.00 / HourEmployment Type: FULL_TIME

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