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Remote Rn Utilization Review Nurse Jobs in Rochester, NY

Rochester Regional Health

Coder - Inpatient

Rochester, NY · On-site +1

$21.50 - $26/hr

SUMMARY Review clinical documentation and diagnostic results to extract data and apply appropriate ... Riedman- Remote SCHEDULE: Day shift ATTRIBUTES * Abides by the Standards of Ethical Coding as set ...

Varsity Tutors

HESI Tutor

Rochester, NY · Remote

$18 - $40/hr

Adapts instruction using HESI practice examinations, science content review guides, and diagnostic assessments to support nursing school applicants seeking competitive admission scores. * Effective ...

Varsity Tutors

TEAS Tutor

Rochester, NY · Remote

$18 - $40/hr

Adapts instruction using ATI official TEAS practice materials, anatomy review guides, and diagnostic assessments to support nursing school applicants seeking competitive scores for program admission.

DataAnnotation

Phlebotomists - AI Trainer

Rochester, NY · Remote

$50 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

DataAnnotation

Medical Assistant - AI Trainer

Rochester, NY · Remote

$50 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

DataAnnotation

Physician - AI Trainer

Rochester, NY · Remote

$50 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

Varsity Tutors

VTNE Tutor

Rochester, NY · Remote

$18 - $40/hr

Deep knowledge of VTNE examination content covering pharmacy and pharmacology, surgical nursing ... review to support veterinary technology graduates preparing for the national credentialing ...

The Bonadio Group

Billing Specialist

Rochester, NY · On-site +1

$21 - $26/hr

... reviews of revenue cycles to determine opportunities for best practice performance. Assist with ... Preferred: * Skilled nursing or private pay billing experience * Billing certification.

ShiftHop LLC

Director of Operations

Rochester, NY · Remote

$85K - $135K/yr

This is a remote position with a residency requirement of Rochester, New York. The ideal candidate ... Familiarity with nursing, post-acute and inpatient healthcare * Resourcefulness and creativity ...

Valera Health

Mental Health Therapist

Rochester, NY · On-site +1

Collaborate within our vetted in-house network of health coaches, therapists, nurse practitioners ... Telehealth or remote experience * Self-motivated with strong independent work skills and ...

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Remote Rn Utilization Review Nurse information

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$21

$41

$68

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

As of Jul 13, 2026, the average hourly pay for remote rn utilization review nurse in Rochester, NY is $41.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 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 Rochester, NY? The most popular types of Rn Utilization Review Nurse jobs in Rochester, NY are:
What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Rochester, NY? For Remote Rn Utilization Review Nurse jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Remote Rn Utilization Review Nurse jobs in Rochester, NY look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Remote Rn Utilization Review Nurse jobs? Cities near Rochester, NY with the most Remote Rn Utilization Review Nurse job openings:
Remote Rn Utilization Review Nurse jobs near you
Coder - Inpatient

Coder - Inpatient

Rochester Regional Health

Rochester, NY • On-site, Remote

$21.50 - $26/hr

Full-time

Posted 25 days ago

Rochester Regional Health rating

7.4

Company rating: 7.4 out of 10

Based on 216 frontline employees who took The Breakroom Quiz

265th of 882 rated healthcare providers

Job description

SUMMARY
Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and ICD-10-PCS codes for billing, internal and external reporting, research, and regulatory compliance. Demonstrate knowledge of reimbursement methodologies and apply these to assigned charts to optimize reimbursement and/or resolve regulatory edits. Resolve error reports associated with billing process, identify and report error patterns, and, when necessary, assist in design and implementation of workflow changes to reduce billing errors
STATUS: Full-time
LOCATION: Riedman- Remote
SCHEDULE: Day shift
ATTRIBUTES
  • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines, and keeps abreast of coding changes and interpretation of codes.
    • Complies with RRH & HIM department policies & procedures
    • Perform detailed review of Inpatient record documentation to identify & assign diagnosis & procedure codes using ICD-10-CM and ICD-10-PCS.
    • Meets established departmental productivity guidelines with 95% accuracy on a consistent basis.
    • Utilizes Care Connect, UDS and Clintegrity systems proficiently to obtain ICD10 codes and DRG assignment.
    • Formulates compliant Physician Coding Queries when documentation is inadequate, ambiguous or unclear for coding purposes
    • Enters and/or updates data accurately including Present on Admission (POA) indicators, Point of Origin, Discharge Disposition and other identified data.
    • Manages problematic workflow edits and other technical issues to ensure timely resolution specific to coding A/R days
    • Corrects failed claim errors to billing edits, accounts misclassified and/or other errors identified through various auditing processes in a timely manner.
    • Attends RGHS, HIM Department and Coding Team meetings and training sessions as required.
    • Ensure timely reporting for external regulations
    • Completes other duties as assigned by HIM leadership.
    • Provide assistance to customers (physicians, clinical quality staff) regarding clinical documentation opportunities, coding reimbursement issues, and quality improvement review process.

RESPONSIBILITIES
  • One of the following certifications is required:
    Applicable advance coding certification credential includes: Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder Hospital Based (CPC-H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder Apprentice CPC-A, or a specialty coding certification.
    • Candidate with Associate degree from the and accredited American Health Information Management Associates (AHIMA) are required to sit for the Registered Health Information Technician (RHIT) exam within 1 year of hire
    • At least 2 years of progressive coding experience in a hospital or multi-specialty physician practice setting preferred.
    • For HOMECARE: Homecare Diagnosis Coding Specialist (HCS-D) certification required within 16 months of hire.
    Grandfather Clause:
    • If hired on or before September 30, 2018, 2 years of relevant work experience and one of the following coding certification credentials: Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder - Hospital Based (CPC-H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or a specialty coding certification and Associate's degree in Health Information Management are required.
    Required Licensure/Certification Skills:
    - One of the following certifications is required:
    Applicable advance coding certification credential includes: Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder Hospital Based (CPC-H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder Apprentice CPC-A, or a specialty coding certification.
    • Candidate with Associate degree from the and accredited American Health Information Management Associates (AHIMA) are required to sit for the Registered Health Information Technician (RHIT) exam within 1 year of hire
    • At least 2 years of progressive coding experience in a hospital or multi-specialty physician practice setting Preferred
    • Full CPC certification must be obtained within 24 months if employee holds CPC-A from the American Academy of Professional Coders (AAPC) at time of hire.
    • For HOMECARE: Homecare Diagnosis Coding Specialist (HCS-D) certification required within 16 months of hire.
    Grandfather Clause:
    • If hired on or before September 30, 2018, 2 years of relevant work experience and one of the following coding certification credentials: Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder - Hospital Based (CPC-H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or a specialty coding certification and Associate's degree in Health Information Management are required.
    Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran.

EDUCATION:
AS: Health Information Management (Required)
LICENSES / CERTIFICATIONS:
PHYSICAL REQUIREMENTS:
S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.
PAY RANGE:
$22.00 - $32.00
CITY:
Rochester
POSTAL CODE:
14617
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.

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