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Remote Utilization Management Nurse Jobs in Springfield, OH

Veterans Health Administration

Nurse

Dayton, OH · On-site +1

$76K - $163K/yr

... utilization. * Provides urgent and emergent care to patients with acute and/or chronic medical ... Demonstrates the ability to cope with and manage competing priorities. * Responsible and ...

Gentell

Certified Wound Care Clinician/Nurse

Dayton, OH · On-site +1

Travel arrangements are made and paid for through our travel management system, with reimbursement ... utilization of wound care products - Understanding Medicare documentation and reimbursement ...

All JobsUtilization Management Nurse JobsRemote Utilization Management Nurse JobsRemote Utilization Management Nurse Jobs in Springfield, OH

Remote Utilization Management Nurse information

See Springfield, OH salary details

$19

$38

$62

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

As of Sep 4, 2026, the average hourly pay for remote utilization management nurse in Springfield, OH is $38.09, according to ZipRecruiter salary data. Most workers in this role earn between $30.10 and $43.75 per hour, depending on experience, location, and employer.

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.

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.

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The top searched job categories for Remote Utilization Management Nurse jobs in Springfield, OH are:

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Cities near Springfield, OH 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 Springfield, OH as of August 2026, with employment types broken down into 92% Full Time, and 8% Part Time. Highlights an 100% Remote job distribution, with an average salary of $79,217 per year, or $38.1 per hour.

Clinical Care Reviewer II - RN - IN MCD - IN or MSL Licensed

CareSource

Dayton, OH • On-site, Remote

$62K - $100K/yr

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

210th of 315 rated insurance

Job description

Job Summary:
Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring the delivery of healthcare services.
Essential Functions:
  • Complete prospective, concurrent and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment
  • Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care
  • Engage with medical director when additional clinical expertise if needed
  • Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards
  • Identify and refer quality issues to Quality Improvement
  • Identify and refer appropriate members for Care Management
  • Provide guidance to non-clinical staff
  • Provide guidance and support to LPN clinical staff as appropriate
  • Attend medical advisement and State Hearing meetings, as requested
  • Assist Team Leader with special projects or research, as requested
  • Perform any other job related duties as requested.

Education and Experience:
  • Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required
  • Three (3) years clinical experience required
  • Med/surgical, emergency acute clinical care or home health experience preferred
  • Utilization Management/Utilization Review experience preferred
  • Medicaid/Medicare/Commercial experience preferred
Competencies, Knowledge and Skills:
  • Proficient data entry skills and ability to navigate clinical platforms successfully
  • Working knowledge of Microsoft Outlook, Word, and Excel
  • Effective oral and written communication skills
  • Ability to work independently and within a team environment
  • Attention to detail
  • Proper grammar usage and phone etiquette
  • Time management and prioritization skills
  • Customer service oriented
  • Decision making/problem solving skills
  • Strong organizational skills
  • Change resiliency
Licensure and Certification:
  • Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required
  • MCG Certification or must be obtained within six (6) months of hire required
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Travel is not typically required

Compensation Range:
$62,700.00 - $100,400.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Hourly
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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Brand=CareSource

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