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Remote Utilization Management Nurse Jobs in Rochester, NY

IDEX

Assistant Controller

West Henrietta, NY · On-site +1

... utilization, and labor/burden studies Participate in analysis of consolidated operations/cost ... This position is a remote role; however, we are seeking candidates who reside within reasonable ...

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · Remote

$65K - $120K/yr

... management of assigned therapists when necessary * Perform ongoing review of high-risk cases and ... Engage in the Utilization Review process for assigned cases every month * Respond to clinical ...

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

As of Jul 19, 2026, the average hourly pay for remote utilization management nurse in Rochester, NY is $41.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 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 the most commonly searched types of Utilization Management Nurse jobs in Rochester, NY? The most popular types of Utilization Management Nurse jobs in Rochester, NY are:
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What cities near Rochester, NY are hiring for Remote Utilization Management Nurse jobs? Cities near Rochester, NY with the most Remote Utilization Management Nurse job openings:
Remote Utilization Management Nurse jobs near you
Health Insurance & Authorization Specialist II

Health Insurance & Authorization Specialist II

Highland Hospital

Rochester, NY • On-site, Remote

$20.99 - $28.34/hr

Other

Re-posted 29 days ago

Highland Hospital (New York) rating

7.7

Company rating: 7.7 out of 10

Based on 24 frontline employees who took The Breakroom Quiz

211th of 1,020 rated hospitals

Job description

he Health Insurance and Authorization Specialist is responsible for verifying patient insurance eligibility and coverage and securing third-party payer authorization for our urgent/emergent inpatients, observation cases, maternity, and newborn admissions and notifies Utilization Management of clinical requests during the hospital stay.  The Specialist also works closely with the uninsured/underinsured for appropriate referrals to our Financial Case Management team to assess patients for health insurance or financial assistance.  They track our Medicare patients for benefit exhaustion to ensure compliance with Medicare Life Time Reserve (LTR) consent forms and consistently exercise judgment to resolve insurance barriers on the assigned admissions to avoid billing delays.  This role involves a more significant amount of external coordination with outside agencies, including MVA/WC carriers, Motor Vehicle Accident Indemnification Corporation (MVAIC) agency, attorney offices, and works with parents to add their newborn through the NYS Marketplace or employer group.
Supervision:              Responsible for monitoring own performance on assigned tasks.  Self-directed and must make complex decisions independently.  May train other support staff.
                                   
                                    This role may have the option to work a hybrid-remote schedule and communicate daily through virtual meetings.
Salary Range:
$20.99-  $28.34 an hour
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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