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Remote Utilization Management Nurse Jobs in Racine, WI

MDS Solutions

REMOTE MDS Coordinator

Milwaukee, WI · Remote

$33.75 - $43/hr

Provide Medicare, Medicaid (case mix), and Managed Care oversight to ensure appropriate clinical ... Nursing Experience in MDS Assessment: 3+ year * RN required * RAC-CT preferred * Thorough ...

Humana

Manager, Care Management

Waukegan, IL · Remote

Become a part of our caring community The Manager, Care Management leads teams of nurses, social ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Humana

Manager, Care Management

Waukegan, IL · Remote

Become a part of our caring community The Manager, Care Management leads teams of nurses, social ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Humana

Manager, Care Management

Waukegan, IL · Remote

Become a part of our caring community The Manager, Care Management leads teams of nurses, social ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Mondo

Project Manager

Racine, WI · Remote

$50 - $70/hr

Hybrid, Racine, WI (Onsite preferred; remote candidates must be available for onsite visits once a ... Track and report on budget utilization and resource allocation to support informed decision-making ...

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Remote Utilization Management Nurse information

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$39

$64

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

As of Jul 26, 2026, the average hourly pay for remote utilization management nurse in Racine, WI is $39.65, according to ZipRecruiter salary data. Most workers in this role earn between $31.35 and $45.53 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.
More about Remote Utilization Management Nurse jobs
What are popular job titles related to Remote Utilization Management Nurse jobs in Racine, WI? For Remote Utilization Management Nurse jobs in Racine, WI, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management Nurse jobs in Racine, WI look for? The top searched job categories for Remote Utilization Management Nurse jobs in Racine, WI are:
What cities near Racine, WI are hiring for Remote Utilization Management Nurse jobs? Cities near Racine, WI 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 Racine, WI as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $82,465 per year, or $39.6 per hour.

Utilization Review Specialist-Remote

Wellbrook Recovery

Brookfield, WI • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 23 days ago

Job description

Utilization Review Specialist – Behavioral Health Facility

We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance authorizations, and collaborating with providers to support appropriate and timely care for our clients.

Responsibilities:

  • Conduct utilization reviews and obtain prior authorizations from insurance companies

  • Monitor continued stay and discharge criteria for clients

  • Communicate effectively with clinical and administrative teams

  • Maintain accurate and up-to-date documentation

  • Ensure all documentation meets insurance and regulatory compliance standards and is completed accurately and on time.

Qualifications:

  • Background or experience in social work, counseling, or behavioral health is preferred

  • Experience in utilization review or case management for behavioral health is preferred

  • Strong communication and organization skills

  • Ability to work efficiently in a fast-paced environment

  • Confident, proactive, and dedicated work ethic

Benefits: Competitive salary Opportunities for professional development and career advancement Supportive and collaborative work environment Fulfilling work helping individuals with mental health or substance abuse issues

Benefits:

  • 401(k)

  • Dental insurance

  • Flexible schedule

  • Health insurance

  • Life insurance

  • Paid time off

  • Vision insurance