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Remote Utilization Management Nurse Jobs (NOW HIRING)

Intus Care

Contract Utilization Management Nurse

$42/hr

Contract Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically ... This is a fully remote role based in the United States. Sponsorship: This position is not eligible ...

INTUS INC

Contract Utilization Management Nurse

$42/hr

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

Intus, Inc

Contract Utilization Management Nurse

$42/hr

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

Valenz

Utilization Management Nurse

Phoenix, AZ · Remote

About This Opportunity: As a Utilization Management Nurse, you'll oversee and manage the ... This is a fully remote position, and we'll provide all the necessary equipment! * Work Environment:

Valenz Health

Utilization Management Nurse

Phoenix, AZ · On-site +1

About This Opportunity: As a Utilization Management Nurse, you'll oversee and manage the ... This is a fully remote position, and we'll provide all the necessary equipment! * Work Environment:

Mass General Brigham

Utilization Management Nurse BWH

$41.71 - $105.65/hr

Job Summary Staff Nurse - Per Diem Rotating Day - BWH Utilization Management The Insurance Support ... Additional Job Details (if applicable) Remote Type Remote Work Location 45 Francis Street Scheduled ...

Oak St. Health

Utilization Management Nurse Consultant

$29.10 - $62.32/hr

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ... Fully Remote- WFH Schedule: Monday-Friday 10:30AM- 7:30PM Position Summary: UM Nurse Consultant ...

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $56.14/hr

Remote (Central Time) * Utilizes clinical experience and skills in a collaborative process to ... N licensure in state of residence Utilization Management is a 24/7 operation and work schedules ...

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $56.14/hr

Registered Nurse (RN) - Utilization Management (24/7 Operations) Step away from bedside care and make a system-wide impact. Join our Utilization Management team and help ensure members receive the ...

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

As of Aug 13, 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?

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
Infographic showing various Remote Utilization Management Nurse job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 86% Full Time, 6% Part Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Contract Utilization Management Nurse

Intus Care

Remote

$42/hr

Other

Posted 10 days ago

Job description

Contract Utilization Management Nurse

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.

The Contract 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 include 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. Active involvement in various aspects of the utilization management process, including concurrent review of all hospital admissions, retrospective review of inpatient admissions under 48 hours, and claims submitted inconsistent with the service authorization. Coordination and 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, and maintain accurate records of all patient related interactions. Appeal Management - In cases of claim rejection, the IntusCare Utilization Management Nurse will lead the provider appeals process. Responsibilities include comprehensive review of provider network appeals and 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 include 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, and excellent communication and leadership abilities, capable of motivating and guiding teams toward timely and efficient care management strategies.

What We Offer includes a chance to be a part of a trailblazing team in healthcare technology, a collaborative, inclusive, and dynamic work environment.

Compensation: The range for this role is $42.00/Hour.

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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