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Remote Rn Utilization Review Nurse Jobs (NOW HIRING)

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Concurrent Utilization Review (UR) Nurse

OR · Remote

$30 - $38/hr

Concurrent Utilization Review (UR) Nurse Remote Opportunity Contract to Hire Must be licenses in ... Registered Nurse (RN) with an active, unrestricted California nursing license required; BSN ...

Actalent

Utilization Management Rn - Remote

$34 - $40/hr

Review approximately 20 cases a day for medical necessity. * Advocate for and protect members from ... utilization review, case management, and discharge planning is must * Active RN Compact License is ...

Astrana Health

UM Review Nurse - Remote

$34 - $42/hr

UM Review Nurse - Remote Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to ...

Astrana Health, Inc.

UM Review Nurse

$34 - $47/hr

... Utilization Review Nurse to assist our Health Services Department. In this position, you will ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · On-site +1

$34 - $47/hr

... Utilization Review Nurse to assist our Health Services Department. In this position, you will ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

Engage Consulting

REMOTE RN MDS CONSULTANT

Toledo, OH · On-site +1

Job Type Full-time Description REMOTE RN MDS CONSULTANT-Full Time Engage Consulting is seeking an ... Responsibilities: • Complete, review, and oversee MDS assessments in accordance with federal and ...

Franciscan Health

Utilization Review Coordinator

Registered Nurse (RN - Indiana licensure) required * 3 years of nursing/patient care experience ... Utilization Review Coordinator $56971.20-$84749.60 INCENTIVE: Not Applicable EQUAL OPPORTUNITY ...

Astrana Health

UM Review Nurse - Remote

Monterey Park, CA · Remote

$34 - $47/hr

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services ... This is a remote position for CA-licensed nurses. Candidates may reside in any state, but will be ...

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Remote Rn Utilization Review Nurse information

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$68

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

As of Jun 29, 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 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, 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.
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 June 2026, with employment types broken down into 80% Full Time, 17% Part Time, 2% Contract, and 1% Nights. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Management Specialist

Utilization Management Specialist

System One

Baltimore, MD • Remote

Contractor

Medical, Dental, Vision, Life, Retirement

Posted 6 days ago

Job description

Utilization Management Specialist (UM / Utilization Review Nurse) — Remote

Location: 100% Remote (U.S.) — Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension) Schedule: Mon–Fri, 8:00am–5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am–9:00am ET Pay (W2): USD 51.00/H

Job overview

In this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You’ll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.

What you’ll do

  • Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).
  • Make medical necessity / appropriateness determinations and support prior authorizations.
  • Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines).
  • Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines.
  • Research diagnoses/treatments and high-cost services; summarize findings and escalate complex cases to Medical Directors as needed.
  • Collaborate with internal partners and providers to support benefit application and appropriate levels/settings of care.
  • Maintain accurate documentation and protect PHI while managing a busy caseload.

Required qualifications

  • Active RN or LPN license (RN preferred) — Maryland compact/eligibility required
  • 5+ years clinical nursing experience
  • 2+ years care management / utilization management experience
  • MCG experience (required)
  • Experience supporting Commercial/FEP/Medicare lines of business and applying medical policy/regulatory standards
  • Strong critical thinking, written communication, and ability to work independently in a remote setting
  • Comfortable with web-based tools + Microsoft Office (Word/Excel/PowerPoint)
  • Guiding Care and FACETS (required)

Nice to have

  • Critical Care or ER clinical background
  • Experience with LCD/NCD, Medicare guidelines, ASAM, or other authorization criteria sets

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1

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