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Remote Utilization Management Nurse Jobs in Springfield, OH

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 ...

Pacs

Interim Biller 6 Months

Spring Valley, OH · Remote

$35 - $36/hr

Interim Biller 6 months - Skilled Nursing Facility (SNF) Location: Fresno, CA (Open to Remote ... Position Summary The Biller is responsible for managing the full cycle of billing and collections ...

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Remote Utilization Management Nurse information

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$19

$38

$62

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

As of Aug 11, 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 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 popular job titles related to Remote Utilization Management Nurse jobs in Springfield, OH? For Remote Utilization Management Nurse jobs in Springfield, OH, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management Nurse jobs in Springfield, OH look for? The top searched job categories for Remote Utilization Management Nurse jobs in Springfield, OH are:
What cities near Springfield, OH are hiring for Remote Utilization Management Nurse jobs? 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.

Optometrist - Remote

Health Partners of Western Ohio

New Carlisle, OH • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 20 days ago

Job description

Optometrist (Remote) - School Based Outreach
This is a full-time position following the assigned school districts school year and paid all year round.
(Monday through Friday 7:30am - 4:00pm)
The school year includes all working days for teachers, including remote work days, and is subject to potential modifications throughout the school year.
POSITION PURPOSE
The Optometrist is primarily responsible for examining the eyes and other parts of the visual system. In addition, the Optometrist will also diagnose and treat visual problems and manage diseases, injuries, and other disorders of the eyes. The Optometrist will also prescribe eyeglasses or contact lenses as needed. The Optometrist will promote eye health and counsel patients on how general health can affect eyesight. Position can be located remote or hybrid.
QUALIFICATIONS
EDUCATION/CERTIFICATION: Must complete a Doctor of Optometry (O.D.) degree program from an accredited optometry school and complete all sections of the National Board of Examiners in Optometry exam. Current license to practice as a Doctor of Optometry (O.D.).
REQUIRED KNOWLEDGE: Successful completion of in-house training.
EXPERIENCE REQUIRED: Minimum of 5 years as a practicing Doctor of Optometry (O.D).
BENEFITS:
  • Paid Time Off (PTO)
  • Insurance (Medical, Dental, and Vision)
  • Paid Holidays
  • 403b Retirement with up to 8% match (starts at 3% and increases with time of service at HPWO)
  • Eligible to Apply for National Health Service Corps Loan Repayment
  • Continuing Education Money ($3,000) that can be used for license, DEA, memberships, CE classes and travel expenses.
  • Annual Raises
  • Training Opportunities
ESSENTIAL FUNCTIONS AND BASIC DUTIES:
  • Assist with establishing vision policies, quality improvement procedures, and evaluating current practices, policies, and procedures.
  • Staying abreast of changing healthcare landscape and opportunities for utilization of technologies to support the enhanced provision of vision services for patients.
  • Maintain supervision and communication with optical and support staff to optimize quality clinical care and services.
  • Provides leadership in developing the vision care plan and review of the program requirements; and recommends changes when necessary to carry out the vision plan as required.
  • Assist the Clinical Director in designing, implementing, and evaluating educational programs for the Health Partners of Western Ohio patients and vision staff.
  • Assume quality care for all patients.
  • Complete patient history and conduct eye examinations using optometric equipment and general diagnostic interpretation.
  • Diagnose sight problems, such as nearsightedness or farsightedness, and eye diseases, such as glaucoma.
  • Prescribe eyeglasses, contact lenses, and other visual aids, and if state law permits, medications.
  • Provide treatments such as vision therapy or low-vision rehabilitation.
  • Evaluate patients for the presence of other diseases and conditions, such as diabetes or hypertension, and refer patients to other healthcare providers as needed.
  • Promote eye and general health by counseling patients.
  • Analyze test results and develop a treatment plan.
  • Adhere to the highest standards of vision practice, ethics, and professionalism.
  • Recommend changes in all vision areas, and/or general areas to improve the patient flow, medical records, billing practices, and appointment practices.
  • Document all patient care provided according to policy.
  • Formulate and direct a plan of care for the patient.
  • Refer to physicians or specialists, as needed.
  • Respond to vision emergencies.
  • Other duties as required by the funding agencies to carry out contractual agreements and/or as established by the Health Partners of Western Ohio, Management and Board of Directors.
  • Must become familiar with the Federal and State rules, regulations, and practices in a Community Health Center.
  • Become familiar with Federal and State Health care program requirements and assist in carrying out these programs.
  • Assist in developing the vision care plan and review of the program requirements; and recommend changes when necessary to carry out the vision plan as required.
  • Adhere to the Health Partners of Western Ohio Integrated Health Care Philosophy.
  • Participate in Performance Improvement/Risk Management Program.
  • Utilize supplies cost-effectively while ensuring that the vision department stays within budget.
  • Participate in continuing education and professional growth.
  • Maintain knowledge of, and complies with, personnel and Vision policies and procedures.
  • Adhere to the standards and policies of the Organizational Privacy/ Security and Compliance Programs, including the duty to comply with applicable laws and regulations (HIPAA, OSHA, OIG guidelines, and other State and Federal laws).
  • Promote eye and general health by counseling patients.
  • Analyze test results and develop a treatment plan.
  • Adhere to the highest standards of vision practice, ethics, and professionalism.
  • Recommend changes in all vision areas, and/or general areas to improve the patient flow, medical records, billing practices, and appointment practices.
  • Document all patient care provided according to policy.
  • Formulate and direct a plan of care for the patient.
  • Refer to physicians or specialists, as needed.
  • Respond to vision emergencies.
  • Other duties as required by the funding agencies to carry out contractual agreements and/or as established by the Health Partners of Western Ohio, Management and Board of Directors.
  • Must become familiar with the Federal and State rules, regulations, and practices in a Community Health Center.
  • Become familiar with Federal and State Health care program requirements and assist in carrying out these programs.
  • Assist in developing the vision care plan and review of the program requirements; and recommend changes when necessary to carry out the vision plan as required.
  • Adhere to the Health Partners of Western Ohio Integrated Health Care Philosophy.
  • Participate in Performance Improvement/Risk Management Program.
  • Provide services in office and throughout community in an outreach manner.
  • May be responsible for driving HPWO vehicle to provide services.
  • Employee is to follow all policies and procedures regarding company vehicle.
  • The position is responsible for other duties as assigned.
WORK ENVIRONMENT
Work is primarily sedentary, demanding sitting, walking, lifting, and bending. Those physical movements and the degree of mobility, manual dexterity, and hand-eye coordination commonly associated with duties in an office setting will be performed repetitively. This also includes bending, twisting, reaching, lifting, pulling, pushing, and walking. The ability to distinguish letters and symbols and utilize telephones, computer terminals, fax machines, and copiers is required. The work environment characteristics described here represent those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. Working under stressful conditions, as well as irregular hours, may be required.

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