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Remote Rn Utilization Review Nurse Jobs in Raleigh, NC

Valeris

Remote Registered Nurse (RN) Case Manager

Raleigh, NC · Remote

$50K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus. * Case ... Remote work eligibility is subject to all work from home criteria met and based on business need.

Cityblock Health

Lead RN - NC - Primarily Remote

Raleigh, NC · Remote

$100K - $115K/yr

  • Medical

  • Life

  • Retirement

  • PTO

The RN Lead also oversees care delivery workflows, resolves daily operational challenges, and ... Conducts regular check-ins and performance reviews to reinforce expectations, support effective ...

Avacend Inc

Registered Nurse (RN)

Cary, NC · Remote

$55/hr

Must be an RN licensed in North Carolina with a multi-state compact nursing license. Must have a least 5 years of nursing experience. Perks to this assignment: OSW will be trained with preceptor and ...

Varsity Tutors

NCLEX-RN Tutor

Chapel Hill, NC · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Durham, NC · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Raleigh, NC · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Veterans Health Administration

Nurse - Operating Room

Durham, NC · On-site +1

$82K - $155K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The RN will be fully qualified and certified to function in a clinical role and in accordance with ... reviews, and training. Ability to communicate in a professional manner and possess appropriate ...

Fortrea

Doc Review Specialist I - US Remote based

Durham, NC · Remote

$60K - $70K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

This is full time, remote exempt opportunity based in US. Key / Core Responsibilities Review ... nursing certification, medical or laboratory technology). Fluent in English, both written and ...

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All JobsRn Utilization Review Nurse JobsRemote Rn Utilization Review Nurse JobsRemote Rn Utilization Review Nurse Jobs in Raleigh, NC

Remote Rn Utilization Review Nurse information

See Raleigh, NC salary details

$20

$41

$67

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

As of Aug 12, 2026, the average hourly pay for remote rn utilization review nurse in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 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 Raleigh, NC? The most popular types of Rn Utilization Review Nurse jobs in Raleigh, NC are:
What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Raleigh, NC? For Remote Rn Utilization Review Nurse jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Remote Rn Utilization Review Nurse jobs in Raleigh, NC look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs in Raleigh, NC are:
Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in Raleigh, NC as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Re-posted 5 days ago

Job description

About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
•    Collaborates with healthcare partners to ensure timely review of services and care.
•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.
•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
•    Duties as assigned.
Essential Qualifications
•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
•    Must be able to work independently.
•    Must be detail oriented and have strong organizational and time management skills.
•    Adaptive to a high pace and changing environment- flexibility in assignment.
•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
•    Proficient in MCG and CMS criteria sets
•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
•    Working knowledge of URAC and NCQA.
•   2+ years’ experience in a UM team within managed care setting.
•   3+ years’ experience in clinical nurse setting preferred.
•   TPA Experience preferred.
 

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