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Remote Rn Utilization Review Nurse Jobs (NOW HIRING)

CommonSpirit Health

Job Summary and Responsibilities As our Utilization Review Nurse at the Utilization Management Hub ... Registered Nurse with current California License required. * Minimum two (2) years of acute ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. * 3 ...

SPECTRAFORCE

Utilization Review Nurse

Washington, DC · Remote

Fully Remote (PST Time Zone - WA/OR Resident)Duration: 12-Month (Potential for Extension)About the ... RN license (WA; must be in good standing)2-4 years of Prior Authorization review and InterQual ...

IMCS Group

Utilization Review Nurse

Manhattan, NY · Remote

$35 - $43/hr

Remote (California only - must reside in CA or hold an active CA RN license) Duration: 12 months ... About the Role The Clinical Review Nurse - Concurrent Review will perform utilization management ...

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

... all Utilization Management activities to include review of inpatient and outpatient medical ... Required Qualifications: RN Notes: Remote Contract to Hire VIVA is an equal opportunity employer.

Ascension

Registered Nurse Utilization Review

Austin, TX · Remote

$84K - $118K/yr

Remote Facility: Ascension Network Services Department: Utilization Management Schedule: Days l ... Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state ...

Ascension

RN Utilization Review

Austin, TX · Remote

$84K - $118K/yr

Remote Facility: Ascension Network Services Department: Utilization Management Schedule: Full Time ... Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...

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

As of Jun 5, 2026, the average hourly pay for remote rn utilization review nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

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.

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 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.

More about Remote Rn Utilization Review Nurse jobs
What cities are hiring for Remote Rn Utilization Review Nurse jobs? Cities with the most Remote Rn Utilization Review Nurse job openings:
What are the most commonly searched types of Rn Utilization Review Nurse jobs? The most popular types of Rn Utilization Review Nurse jobs are:
What states have the most Remote Rn Utilization Review Nurse jobs? States with the most job openings for Remote Rn Utilization Review Nurse jobs include:
What job categories do people searching Remote Rn Utilization Review Nurse jobs look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs are:
Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in the United States as of May 2026, with employment types broken down into 1% Locum Tenens, 64% Full Time, 9% Part Time, and 26% Contract. Highlights an 98% Physical, and 2% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
RN Utilization Review

RN Utilization Review

CommonSpirit Health

Remote

Part-time

Posted 12 days ago

CommonSpirit Health rating

7.1

Company rating: 7.1 out of 10

Based on 502 frontline employees who took The Breakroom Quiz

370th of 865 rated healthcare providers

Job description


Job Summary and Responsibilities

As our Utilization Review Nurse at the Utilization Management Hub, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making, regulatory compliance, and responsible resource utilization.

Every day you will meticulously review medical records, authorize services, and prepare cases for physician review in partnership with UM teams. You'll monitor patient care for appropriateness, quality, and cost-effectiveness, aligning decisions with established criteria. 

To be successful in this role, you will possess a strong clinical background, deep UM/regulatory knowledge, and exceptional analytical/organizational skills. Your ability to manage charts, apply criteria precisely, and communicate effectively with enthusiasm, efficiency, and empathy is paramount for optimal patient care and operational flow.

  • Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking.  Reviews include admission, concurrent and post discharge for appropriate status determination.
  • Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
  • Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers. 
  • Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes.
  • Collaborates with facility RN Care Coordinators to ensure progression of care.
  • Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status.
Job Requirements

Required:

  • Graduate of an accredited school of nursing
  • Registered Nurse with current California License required.
  • Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience required.
  • Must be available to complete training on-site at Northridge Hospital. 
  • Every other weekend required.

Prefered: 

  • Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred.
  • Knowledge of managed care and payer environment preferred.
  • Must have critical thinking and problem-solving skills.
  • Bachelor's Degree in Nursing (BSN) or related healthcare field Preferred.
  • LA City Fire Card required within 90 days of hire.
Where You'll Work

Founded in 1955, Dignity Health - Northridge Hospital Medical Center is a 394-bed, acute care, nonprofit hospital located. Serving over 80,000 patients annually, the hospital offers a full complement of services including a Level II Trauma Center, heart care, cancer care and women’s health. It is the only pediatric trauma center in the San Fernando Valley. 

Additionally, Northridge Hospital Medical Center has been recognized as an LGBTQ+ Healthcare Equality High Performer by the Human Rights Campaign Foundation. It is a Joint Commission-certified Thrombectomy-Capable Stroke Center and has been recognized as one of America’s 50 Best Hospitals by Healthgrades in 2026.

One Community. One Mission. One California 

Qualifications:

Required:

  • Graduate of an accredited school of nursing
  • Registered Nurse with current California License required.
  • Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience required.
  • Must be available to complete training on-site at Northridge Hospital. 
  • Every other weekend required.

Prefered: 

  • Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred.
  • Knowledge of managed care and payer environment preferred.
  • Must have critical thinking and problem-solving skills.
  • Bachelor's Degree in Nursing (BSN) or related healthcare field Preferred.
  • LA City Fire Card required within 90 days of hire.
Employment Type: Part Time

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