ZipRecruiter

Log In

2

Remote Rn Utilization Review Nurse Jobs in Raleigh, NC

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 ...

CommWell

RN Care Manager

Four Oaks, NC · On-site +1

Now Hiring: RN Care Manager Join a team that's been providing compassionate, patient-centered care ... Reviewing charts to assign acuity levels and assign patients to the appropriate care team

ATULO HEALTH INC

PRN Home Infusion RN

Durham, NC · Remote

Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...

Apply Early

ATULO HEALTH INC

PRN Home Infusion RN

Raleigh, NC · Remote

Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...

Apply Early

York Risk Services

RN Field Case Manager

Raleigh, NC · On-site +1

$75K - $96K/yr

... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...

next page

Showing results 1-20

All 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 Jul 2, 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.

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 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:
What cities near Raleigh, NC are hiring for Remote Rn Utilization Review Nurse jobs? Cities near Raleigh, NC 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 Raleigh, NC as of June 2026, with employment types broken down into 78% Full Time, 19% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.
UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)

UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)

Alliance

Morrisville, NC • On-site, Remote

$68K - $86K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services, monitors consumer treatment through ongoing and continuous review to ensure that services are delivered based on consumer need and established clinical guidelines, and identifies and follows-up on clinical cases of concern and high-risk/special needs consumers to ensure enrollees are linked to appropriate treatment resources. The UM Clinical Specialist RN - PH may represent the unit in cross agency collaborative needs.
This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to one of the offices for onsite team meetings as needed.
Responsibilities & Duties
Assesses the medical necessity of services
  • Independently conduct medical necessity reviews of service requests submitted by service providers against developed clinical guidelines within contractually mandated turn-around times
  • Ensure authorized services address appropriate service needs, intensity of service outcomes, and alternatives for consumers
  • Provide a consistent application of medical necessity criteria for physical health services that promotes a holistic review of the member's needs
  • Conduct pre-certification, concurrent, and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts
  • Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice standards
  • Notify members of adverse benefit determinations while preserving members' Due Process rights
  • Ensure compliance with performance measures outlined within all accrediting body standards
  • Perform other related duties as required by the immediate supervisor or other designated Alliance Health administrators

Compliance
  • Comply with utilization management and quality improvement policies and procedures, utilization review laws and regulations, state standards
  • Comply with Utilization Management Department focus on timeliness, effectiveness, quantity, quality, and cost of services for eligible enrollees

Coordinate and Implement UM Processes
  • Participate in the integration of the department and its functions into the organization's primary mission
  • Take part in the Utilization Management Department collaboration to ensure an integrated department with Physical Health and Behavioral Health

Collaborate with other departments
  • Monitor for undesirable performance or deviations of practice standards that may have a negative impact on consumers.
  • Respond through additional follow-up with consumer and providers, provider technical assistance and/or referral to other departments within the MCO.
  • Maintain open, timely communication with staff, providers, community agencies and other stakeholders

Minimum Requirements
Education & Experience
Graduation from a State accredited school of nursing or an Associate's Degree in Nursing from an accredited and five years of experience with five (5) years nursing experience
OR
Bachelor's degree in Nursing from an accredited college/university and three (3) years of nursing experience
Special Requirement-
Current, active, and unrestricted North Carolina clinical license as a Registered Nurse, or a compact license
Preferred Experience:
Experience in Utilization Management
Knowledge, Skills, & Abilities
  • Knowledge of physical health and co-morbid health conditions
  • Knowledge of diagnostic treatment guidelines/protocols, level of care criteria
  • Proficient in the use of computer and multiple software programs.
  • Written and oral communication skills
  • Ability to interact with a wide variety of individuals and handle complex and confidential sensitive situations.
  • Knowledge of Utilization Management managed care principles and strategies
  • Ability to analyze effectiveness of processes and adjust developed processes.
  • Knowledge of and experience in acute clinical utilization review
  • Knowledge of Authorization/re-authorization Utilization Management standards
  • Knowledge of related duties in the delivery of patient care, management of patient care providers, or project management in a healthcare environment
  • Ability to lead, delegate and problem solve
  • Ability to develop and document workflows
  • Ability to assist appeal efforts when medical care is denied by various payor entities in a timely fashion.
  • Knowledge of and experience with NCQA

Employment for this position is contingent upon a satisfactory background, which will be performed after acceptance of an offer of employment and prior to the employee's start date.
Salary Range
$68,227-$86,990/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
  • Medical, Dental, Vision, Life, Long Term Disability
  • Generous retirement savings plan
  • Flexible work schedules including hybrid/remote options
  • Paid time off including vacation, sick leave, holiday, management leave
  • Dress flexibility

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

Apply