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Remote Rn Utilization Review Nurse Jobs in Philadelphia, PA

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Trenton, NJ · Remote

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Registered Nurse (RN) - Home Care Job Type: Part-Time / Per Diem Location: New Jersey We are a home ... Develop, review, and update care plans. * Monitor clients and follow up on their care needs.

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Chester, PA · Remote

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

As of Aug 10, 2026, the average hourly pay for remote rn utilization review nurse in Philadelphia, PA is $42.67, according to ZipRecruiter salary data. Most workers in this role earn between $33.70 and $48.99 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 Philadelphia, PA? The most popular types of Rn Utilization Review Nurse jobs in Philadelphia, PA are:
What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Philadelphia, PA? For Remote Rn Utilization Review Nurse jobs in Philadelphia, PA, the most frequently searched job titles are:
What job categories do people searching Remote Rn Utilization Review Nurse jobs in Philadelphia, PA look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs in Philadelphia, PA are:
What cities near Philadelphia, PA are hiring for Remote Rn Utilization Review Nurse jobs? Cities near Philadelphia, PA 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 Philadelphia, PA as of August 2026, with employment types broken down into 84% Full Time, 5% Part Time, and 11% Contract. Highlights an 100% Remote job distribution, with an average salary of $88,746 per year, or $42.7 per hour.

Clinical Appeals Nurse - Full Time Remote - Jefferson Health

Thomas Jefferson University Hospitals, Inc.

Philadelphia, PA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted yesterday

Jefferson Health rating

7.7

Company rating: 7.7 out of 10

Based on 348 frontline employees who took The Breakroom Quiz

158th of 887 rated healthcare providers

Job description

Job Details
Reviews payor denials and audits for potential lost revenue. Writes comprehensive, factual arguments to present to third-party payers, medical review boards, or other responsible parties applying clinical criteria to establish medical necessity. Functions as a hospital liaison with external third-party payors to appeal denied claims. Works closely with Physician advisor team to facilitate appeals to payors. Monitors and reports payor trends to management team.
Job Description
Clinical Appeals Nurse - Full Time Remote - Jefferson Health
Articulates the job's main responsibilities. This is not intended to be an exhaustive list of all essential functions or all duties performed. The essential functions listed below and percentage of time may vary between departments and locations, and are subject to change based on management discretion and organizational needs. Other responsibilities may be assigned at the discretion of management to meet organizational needs.
  • Creates an appeal letter to uphold the procedure based on medical policy guidelines of the payor and the documentation found in the hospital/physician information system.
  • Facilitates write off accounts that cannot provide adequate medical necessity or documentation for the payor to meet their guidelines.
  • Investigates and coordinates completion of patient records required to retrospectively precertify accounts and appeal insurance denials.
  • Contacts insurance companies and conducts appeals via telephone or email.
  • Coordinates appeals that need a physician's input for the payor and writes off claims that have no further appeal rights.
  • Identifies areas for revenue loss due to documentation or processes not being reimbursable thru payors.
  • Ensures that all appeals are sent to the correct payor within the appeal guidelines.
  • Ensures compliance with regulatory and accrediting requirements.
  • Reviews claim documentation and pulls supporting medical documentation from the system to support the medical policy guidelines of the payor.
  • Searches for supporting clinical evidence to support appeal arguments when existing resources are unavailable.

Qualifications:
The requirements listed below are representative of the knowledge, skill, and/or ability required or preferred.
Education - Required
  • Bachelor's Degree Nursing or
  • Specialized Diploma

Experience - Required
  • 10 years of clinical or case management/utilization review experience

Knowledge, Skills and Abilities - Required
  • Ability to read medical charts and identify deficiencies in documentation content.
  • Ability to adapt to ongoing changes within the health insurance industry in order to effectively implement positive changes.
  • Knowledge of Interqual/medical policy criteria, case management principles, utilization review, and hospital departmental procedures.
  • Knowledge of coding for payment of claims.
  • Insurance knowledge of payors and their unique rules.
  • Epic workflow experience with notes in account history and WQ workflows.
  • Intermediate Excel and MS Word experience.
  • Must complete RCE Training and pass test with 80% or better.

Licenses and Certifications - Required
  • RN - Licensed Registered Nurse_PA - State of Pennsylvania

Work Shift
Workday Day (United States of America)
Worker Sub Type
Regular
Employee Entity
Thomas Jefferson University
Primary Location Address
1101 Market, Philadelphia, Pennsylvania, United States of America
Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.
For more benefits information, please click here

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About Jefferson Health

Sourced by ZipRecruiter

Jefferson Health is a revered name in the healthcare sector, based in Philadelphia, Pennsylvania, US. This nonprofit health system is dedicated to delivering high-quality, compassionate clinical care and services across the region. The organization was founded in 1824 as Jefferson Medical College, and over the years, it has grown into a vast network of physicians and specialists, hospitals, outpatient and urgent care facilities. Offering a comprehensive range of healthcare services, Jefferson Health covers areas including cancer care, neuroscience, orthopedics, and cardiovascular care, among others. The organization's mission is to improve lives by promoting overall health and wellness, emphasizing value-based care, and making innovative medical advancements. Besides, one of their notable achievements includes being recognized by the National Academy of Medicine as a national leader in patient safety improvements.

Industry

Hospitals and health care and social assistance

Company size

10,000+ Employees

Headquarters location

Philadelphia, PA, US

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