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Remote Utilization Management Jobs (NOW HIRING)

BCForward

Utilization Management Nurse

Austin, TX · Remote

$40.14/hr

BCforward is currently seeking a highly motivated PA Clinician - RN - Utilization Management - Remote (Local to Austin TX) Job Title: PA Clinician - RN - Utilization Management Location: (Austin ...

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CorroHealth

Coordinator, Utilization Management

$19 - $20/hr

This is a REMOTE position. Title: Coordinator, Utilization Management Location: Remote (Within US Only) Required Schedule : Tuesday - Saturday, 8:00 AM to 5:00 PM EST and some holiday coverage ...

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Remote Utilization Management information

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$21

$42

$68

How much do remote utilization management jobs pay per hour?

As of Jun 24, 2026, the average hourly pay for remote utilization management 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.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

More about Remote Utilization Management jobs
What cities are hiring for Remote Utilization Management jobs? Cities with the most Remote Utilization Management job openings:
What are the most commonly searched types of Utilization Management jobs? The most popular types of Utilization Management jobs are:
What states have the most Remote Utilization Management jobs? States with the most job openings for Remote Utilization Management jobs include:
What job categories do people searching Remote Utilization Management jobs look for? The top searched job categories for Remote Utilization Management jobs are:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in the United States as of June 2026, with employment types broken down into 84% Full Time, 15% Part Time, and 1% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
REMOTE Utilization Management Associate

REMOTE Utilization Management Associate

Medix

New York, NY • Remote

$20 - $22/hr

Full-time

Posted 22 hours ago

Job description


Utilization Management Associate - Managed Care / Appeals (Remote - Tri-State Area)

We are seeking a detail-oriented and customer-focused Utilization Management CMA to support authorization processing, member/provider communication, and appeals coordination within a fast-paced healthcare environment. This is a fully remote opportunity; however, candidates must reside in the Tri-State area (New York, New Jersey, or Connecticut).


Schedule

Monday - Friday | 9:00 AM - 5:00 PM


Position Overview

The UM CMA will support Utilization Management operations by processing authorization requests, coordinating with providers and members, documenting case activity, and ensuring timely and accurate handling of UM and appeal-related functions. This role requires strong administrative skills, healthcare knowledge, and the ability to work independently in a high-volume environment.


Key Responsibilities
  • Receive and process UM service requests from providers and members through fax, provider portals, call center systems, and other intake channels
  • Handle inbound calls from providers and members while addressing questions related to benefits, policies, procedures, and authorization status
  • Strive to achieve first-call resolution and provide exceptional customer service
  • Verify member eligibility and benefits using internal systems and resource tools
  • Create and complete authorization requests and generate reference numbers
  • Follow established UM workflows to process requests or escalate to clinical staff when appropriate
  • Request and review supporting clinical documentation necessary to determine medical necessity
  • Process inbound correspondence and ensure accurate association with member records
  • Generate approval and denial letters using system correspondence templates
  • Accurately document member, provider, and clinical information within internal systems
  • Support UM appeals by managing authorization updates, outreach efforts, determination notifications, and tracking related activities
  • Participate in departmental projects, audits, regulatory clean-up initiatives, and quality improvement activities
  • Attend ongoing trainings and staff meetings to enhance knowledge and performance
  • Assist team members and perform additional duties as assigned

Qualifications
Required
  • High School Diploma or GED
  • 1-3 years of administrative support experience within Utilization Management or Appeals
  • Strong computer and data entry skills
  • Ability to work efficiently in a high-volume environment
  • Excellent communication and customer service skills

Preferred
  • Understanding of medical terminology including ICD-10, HCPCS, and CPT-4 coding
  • Call center or healthcare customer service experience
  • Self-starter with the ability to work independently
  • Strong organizational and multitasking skills

Ideal Candidate

The ideal candidate is dependable, detail-oriented, and comfortable working in a fast-paced managed care environment. They should be able to work independently while maintaining accuracy, professionalism, and a high level of member and provider support.


For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.
Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?
Medix Staffing Solutions logo

About Medix Staffing Solutions

Sourced by ZipRecruiter

Since 2001, we’ve been dedicated to helping you achieve your goals. Medix was created to become a leading provider of workforce solutions for clients and candidates across the healthcare and life sciences industries. Today, we are that leader. Headquartered in Chicago, we have 23 offices across the United States, and staff talent around the world. Medix is committed to fulfilling our core purpose as an organization: to positively impact the lives of our talent, clients, and teammates through employment, philanthropy, and opportunity. The combination of purpose and values has nurtured our thriving culture that encourages our internal team to excel at work and in everyday life.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

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