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Remote Utilization Management Nurse Jobs in Ohio

Molina Healthcare

Medical Review Nurse (RN)

Columbus, OH · Remote

$29.05 - $56.64/hr

... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... REQUIRED QUALIFICATIONS: • At least 2 years clinical nursing experience, including at least 1 ...

New

Bcbsa

Director, Trade Client Relations

New Hampshire, OH · Remote

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Bcbsa

Director, Trade Client Relations

Delaware, OH · Remote

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Purposelink Recruitment

Remote Nurse Practitioner

OH · Remote

Care Management * Active clinical licensure -- any of the following: * Nurse Practitioner (NP) - ... and remote monitoring * Collaborate with physicians, RNs, social workers, therapists, caregivers ...

New

Imh

$41.20 - $62.17/hr

Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

Imh

RN Care Manager PRN

Cleveland, OH · Remote

$41.20 - $62.17/hr

Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

Imh

$41.20 - $62.17/hr

Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

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Remote Utilization Management Nurse information

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$20

$40

$65

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

As of Aug 10, 2026, the average hourly pay for remote utilization management nurse in Ohio is $40.20, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.15 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.
More about Remote Utilization Management Nurse jobs
What are the most commonly searched types of Utilization Management Nurse jobs in Ohio? The most popular types of Utilization Management Nurse jobs in Ohio are:
What are popular job titles related to Remote Utilization Management Nurse jobs in Ohio? For Remote Utilization Management Nurse jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management Nurse jobs in Ohio look for? The top searched job categories for Remote Utilization Management Nurse jobs in Ohio are:
What cities in Ohio are hiring for Remote Utilization Management Nurse jobs? Cities in Ohio with the most Remote Utilization Management Nurse job openings:
Remote Utilization Management Nurse jobs near you
Infographic showing various Remote Utilization Management Nurse job openings in Ohio as of August 2026, with employment types broken down into 86% Full Time, 8% Part Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $83,610 per year, or $40.2 per hour.

RN Field Behavioral Health Case Manager

Healthcare Support Staffing

Maumee, OH • Remote

Full-time

Re-posted 19 days ago

Job description

Company Description

Are you an experienced Administrative Assistant looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!

Job Description

RN Field Behavioral Health Case Manager will work 70% in the field and 30% remote. The patient members that they will be assessing are dual eligible Medicare/ Medicaid. There duties include; day-to-day operations of the High Risk Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life. RN Field Behavioral Health Case Manager assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management Treatment Plan, monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the High Risk Case Management functions. Collaborate with both medical and behavioral providers to ensure optimal care for members. 

Daily Responsibilities: 

RN Field Behavioral Health Case Manager will be responsible for the Lucas County patient members'

Work telephonically with patients identified as high risk to identify needs, set goals and implement action steps towards achieving goals. 

Empower patients to help them improve their quality of life. 

Comply with established referral, pre-certification and authorization policies, procedures and processes by related Medical Management staff.

RN Field Behavioral Health Case Manager participate in on-going communication between case management staff, utilization management staff, health plan partners and contracted providers.

RN Field Behavioral Health Case Manager will assist with the implementation of policies and procedures regarding case management and utilization management functions.

Working with these members to identify needs and goals to achieve improved quality of life.

Maintain HIPAA compliance.


Qualifications

Requirements: 

MUST have a valid RN License in the State of OH

3 years of Behavioral Health experience 

3-5 years of case and/or utilization management experience.

CCM (Certified Case Manager) or other clinical certification preferred

Hours for this Position: 

Monday - Friday 8 am - 5 pm.   


Advantages of this Opportunity:

Competitive salary

Growing Company

Medical benefits go into effect 30 days after start date



Additional Information


If you are interested in applying to this position, please contact Shanna Ramirez, (407) 636-7030 ext. 170 and click the Green "I'm Interested" Button to email your resume.

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!


The greatest compliment to our business is a referral.If you know of someone looking for a new opportunity, please pass along my contact information!


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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