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Remote Rn Utilization Review Nurse Jobs (NOW HIRING)

Dane Street

PRN Utilization Review Nurse Reviewer

Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a ... Apple equipment and a media stipend are provided for remote workspace. ABOUT DANE STREET: A fast ...

Medica

Utilization Management RN III

$70K - $120K/yr

The Utilization Review RN will review and document member case history in compliance with policies ... Active, unrestricted RN license required This position is a Remote role. To be eligible for ...

Enterprise Engineering

Be Seen First

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 ...

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

As of Aug 10, 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?

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.
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Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 85% Full Time, 5% Part Time, and 10% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse - Remote - Contract

HireOps Staffing, LLC

Dallas, TX • Remote

$41/hr

Full-time

Posted 5 days ago

Job description

Remote position, however, candidates must reside in the State of TX or State of IL

This position is a contract for about 9 months.

Pay:  $41/hour

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. This Position Is Responsible For Performing Accurate And Timely Medical Review Of Claims Suspended For Medical Necessity, Contract Interpretation, Pricing; And To Initiate And/Or Respond To Correspondence From Providers Or Members Concerning Medical Determinations.
Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation. Awareness of claims processes and claims processing systems. PC proficiency to include Microsoft Word and Excel and health insurance databases. Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings. Organizational skills and prioritization skills. :Registered Nurse (RN) with unrestricted license in state. 3 years clinical experience.

Needs to be able to navigate MCG and Medical policies with the reviews.