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Remote Utilization Management Nurse Jobs (NOW HIRING)

Intus, Inc

Utilization Management Nurse

$80K - $95K/yr

Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost ... This is a fully remote role based in the United States. Sponsorship: This position is not eligible ...

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Utilization Management Inpatient Coordinator

Orange, CA · Remote

$23 - $26/hr

This role supports inpatient, and skilled nursing facility (SNF) utilization review workflows ... This position is fully remote and offers a contract-to-permanent hire opportunity based on ...

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How much do remote utilization management nurse jobs pay per hour?

As of Jun 8, 2026, the average hourly pay for remote utilization management 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 Utilization Management Nurse vs Remote Case Manager?

AspectRemote Utilization Management NurseRemote Case Manager
CredentialsRN license, certifications like CCM or ANCCRN license, certifications like CCM or similar
Work EnvironmentHealthcare organizations, insurance companies, telehealthInsurance companies, healthcare providers, telehealth
Job FocusReviewing medical necessity, authorizations, and utilizationCoordinating patient care, discharge planning, resource management

Both roles require RN licensure and similar certifications, often working remotely within healthcare or insurance settings. The main difference lies in focus: Utilization Management Nurses primarily review medical necessity and authorization requests, while Case Managers coordinate patient care and discharge planning. Understanding these distinctions helps job seekers identify the role that best matches their skills and career goals.

What is a Remote Utilization Management Nurse?

A Remote Utilization Management Nurse is a registered nurse who works from a remote location, such as their home, to review patient medical records and determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. Their main responsibilities include reviewing clinical documentation, conducting pre-authorization reviews, and ensuring compliance with healthcare regulations and insurance guidelines.

What Does a Remote Utilization Management Nurse Do?

As a remote utilization management nurse, you work from home to perform a variety of duties and responsibilities, such as corresponding with and interviewing physicians, modifying patient treatment plans, analyzing investigation information, and auditing patient records. As a UM nurse, you may also deal with other clinical tasks, referrals, authorizations, and reviews. You usually work for insurance companies and healthcare providers to help to determine if patients should receive authorization for needed treatments or for those that they already receive. In some cases, you may monitor processes to ensure that hospital patients are getting what they need during their stay.

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

To thrive as a Remote Utilization Management Nurse, you need a valid RN license, clinical experience (often in acute care), and a solid understanding of utilization review and healthcare regulations. Familiarity with case management software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Strong analytical skills, attention to detail, and effective written and verbal communication are essential soft skills for successful remote collaboration and decision-making. These skills ensure accurate assessments, compliance with standards, and the delivery of cost-effective, quality patient care from a remote setting.

What are some common challenges faced by Remote Utilization Management Nurses, and how can they be addressed?

Remote Utilization Management Nurses often face challenges such as maintaining effective communication with interdisciplinary teams, staying updated on changing insurance guidelines, and managing a high volume of case reviews. To address these issues, it's helpful to establish regular virtual check-ins with team members, utilize digital tools for efficient documentation, and participate in ongoing training on payer requirements. Developing strong organizational skills and proactively seeking clarification on complex cases can also contribute to success in this role.
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Remote Utilization Management Nurse jobs near you

Utilization Management Nurse

Intus, Inc

Remote

$80K - $95K/yr

Full-time

Medical, Dental, Vision

Posted 19 days ago

Job description

About IntusCare
IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay compliant. IntusCare replaces outdated technology and manual workarounds with purpose-built solutions for care coordination, risk adjustment, population health, and utilization management. IntusCare empowers teams to take control of their operations and improve outcomes for dual-eligible seniors - some of the most socially vulnerable and clinically complex individuals in the US healthcare system.
Role Overview
The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual partners closely with PACE Interdisciplinary Teams, Medical Directors, and provider networks to review service utilization, guide care decisions and support timely, appropriate transitions across care settings. Blending clinical expertise with analytical thinking, the Utilization Management Nurse ensures services are medically necessary, aligned with care plans and consistent with PACE regulations and best practices. This role is essential to maintaining program integrity, improving participant outcomes and supporting the delivery of coordinated, value-based care.
Responsibilities
  • Rigorous adherence to PACE program service authorization policies, ensuring that participant care and related claims are:
    • Reasonable and necessary for diagnosis or treatment and consistent with PCP coordination decisions.
    • In accordance with accepted medical standards and consistent with the participant care needs including level of care and advanced care planning principles.
  • Active involvement in various aspects of the utilization management process, including:
    • Concurrent review of all hospital admissions (observation and inpatient) with the Interdisciplinary Team driving efficient and timely transitions of care, retrospective review of inpatient admissions under 48 hours, and claims submitted inconsistent with the service authorization.
    • Concurrent review of all subacute and SNF admissions with the Interdisciplinary Team driving efficient and timely discharge plans and transitions of care.
    • Coordination and review of all other services delivered by contracted providers and identified by the PACE program assuring consistency with Interdisciplinary Team service authorization, care plans, and PCP coordination decisions.
  • Employ effective use of knowledge, critical thinking, and skills to:
    • Advocate quality care and enhanced quality of life
    • Advocate decreased hospital stay when appropriate
    • Maintain accurate records of all patient related interactions
  • Appeal Management - In cases of claim rejection, the Intus Care Utilization Management Nurse will lead the provider appeals process. Responsibilities Include:
    • Comprehensive review of provider network appeals.
    • Collaboration with the PACE Program's Medical Director to review and respond to appeal requests, ensuring issuance of a written determination consistent with the PACE program policies.

Qualifications
  • 3 to 5 years of utilization management experience.
  • Current RN license
  • Proven experience working in risk based integrated models of care.
  • Ability to use data to drive decisions and collaboration with internal and external stakeholders.
  • Strong strategic thinking, problem solving, and decision making skills.
  • Excellent communication and leadership abilities, capable of motivating and guiding teams toward timely and efficient care management strategies

What We Offer
  • A chance to be a part of a trailblazing team in healthcare technology.
  • Competitive salary and equity package.
  • Comprehensive benefits including health, dental, and vision insurance.
  • A collaborative, inclusive, and dynamic work environment.
  • Opportunities for professional growth and development

Compensation: The salary range for this role is $80K-$95K. We expect the ideal candidate to fall near the midpoint of this range, though final compensation will be determined based on experience, skills, and organizational needs.
Work location: This is a fully remote role based in the United States.
Sponsorship: This position is not eligible for sponsorship.

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