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Remote Utilization Management Nurse Jobs in Springfield, TN

Charlie Health

Utilization Review Specialist

Nashville, TN · Remote

$62K - $70K/yr

Participate in denial management, appeals, and peer-to-peer review processes Requirements * Active ... REMOTE Please note that this role is not available to candidates in Alaska, Maine, Washington DC ...

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

As of Sep 8, 2026, the average hourly pay for remote utilization management nurse in Springfield, TN is $39.93, according to ZipRecruiter salary data. Most workers in this role earn between $31.54 and $45.87 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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Utilization Review Specialist

Charlie Health

Nashville, TN • Remote

$62K - $70K/yr

Full-time

Re-posted 18 days ago

Key responsibilities

  • Oversees all functions of a virtual IOP caseload

  • Completes pre-certs, authorizations, and peer-to-peer reviews to advocate for treatment and resolve barriers

  • Collaborates with teams and management to improve workflows, troubleshoot processes, and enhance patient experience

Charlie Health rating

8.5

Company rating: 8.5 out of 10

Based on 12 frontline employees who took The Breakroom Quiz

Job description

 Why Charlie Health?

Millions of people across the country are navigating mental health conditions, substance use disorders, and eating disorders, but too often, they're met with barriers to care. From limited local options and long wait times to treatment that lacks personalization, behavioral healthcare can leave people feeling unseen and unsupported.

Charlie Health exists to change that. Our mission is to connect the world to life-saving behavioral health treatment. We deliver personalized, virtual care rooted in connection—between clients and clinicians, care teams, loved ones, and the communities that support them. By focusing on people with complex needs, we're expanding access to meaningful care and driving better outcomes from the comfort of home.

As a rapidly growing organization, we're reaching more communities every day and building a team that's redefining what behavioral health treatment can look like. If you're ready to use your skills to drive lasting change and help more people access the care they deserve, we'd love to meet you.

About the Role

The purpose of this position is to ensure that the utilization process is thorough, organized and streamlined to provide the best possible length of stays for our patients. Given the complex nature of insurance these days, it is crucial to have timely communication with these payors so that families can focus on what's important, getting their loved ones the care they need. 

We're a team of passionate, forward-thinking professionals eager to take on the challenge of the mental health crisis and play a formative role in providing life-saving solutions. If you're inspired by our mission and energized by the opportunity to increase access to mental healthcare and impact millions of lives in a profound way, apply today. 

Responsibilities
  • Oversees all functions of a virtual IOP caseload
  • Collaborates at a high level to problem solve on complex cases with Manager
  • Completes pre-certs and authorizations for virtual IOP clients in a timely manner
  • Completes peer to peer reviews with insurance MDs to advocate for treatment post first line denial outcomes.
  • Follows up on all outstanding authorizations and reports all barriers to Manager
  • Collaborates with Revenue Cycle Team and Admissions to improve patient experience from the front door through discharge Partners with Manager and Director to troubleshoot workflows and processes to achieve efficiency gains in current and future company systems
  • Delivers training to clinical teams for high quality documentation standardization
  • Participate in denial management, appeals, and peer-to-peer review processes 
Requirements
  • Active, Unrestricted Professional License: You must hold a current, active, and unencumbered license to practice independently in a U.S. state or territory. Common credentials include:
    • Physicians: MD or DO (typically Board Certified in Psychiatry or Child/Adolescent Psychiatry).  
    • Psychologists: PsyD or PhD (Licensed Psychologist). 
    • Master's-Level Clinicians: LCSW, LMFT, LPC, or LCPC. 
  • 2+ years of experience in a utilization role within the behavioral health field required
  • Google proficiency 
  • Strong interpersonal, relationship-building and listening skills, with a natural, consultative style 
  • Ability to energize, communicate, and build rapport at all levels within an organization 
  • Strong project management skills, with a demonstrable ability to corral and manage details in a fast-paced, fluid environment 
  • Experience advising, presenting to, and persuading senior corporate personnel 
  • Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations 
  • Familiarity with InterQual, MCG, or similar clinical guidelines 
  • Strong analytical, communication, and documentation skills 
  • Proficiency with electronic medical records (EMR) and utilization management systems 
  • Understanding of HIPAA and patient confidentiality requirements 
Benefits

Charlie Health is pleased to offer comprehensive benefits to all full-time, exempt employees. Read more about our benefits here.

The total target base compensation for this role will be between $62,000 and $70,000 per year at the commencement of employment. In addition to base compensation, this role also offers a performance bonus. The expected total cash compensation range, including potential bonus, will be between $0 and $900 per month. Please note, pay will be determined on an individualized basis and will be impacted by location, experience, expertise, internal pay equity, and other relevant business considerations. Further, cash compensation is only part of the total compensation package, which, depending on the position, may include stock options and other Charlie Health-sponsored benefits. #LI-REMOTE
Please note that this role is not available to candidates in Alaska, Maine, Washington DC, New Jersey, California, New York, Massachusetts, Connecticut, Colorado, Washington State, Oregon, or Minnesota. 

#LI-REMOTE

Our Values
  • Connection: Care deeply & inspire hope.
  • Congruence: Stay curious & heed the evidence.
  • Commitment: Act with urgency & don't give up.

Please do not call our public clinical admissions line in regard to this or any other job posting.

Please be cautious of potential recruitment fraud. If you are interested in exploring opportunities at Charlie Health, please go directly to our Careers Page: https://www.charliehealth.com/careers/current-openings. Charlie Health will never ask you to pay a fee or download software as part of the interview process with our company. In addition, Charlie Health will not ask for your personal banking information until you have signed an offer of employment and completed onboarding paperwork that is provided by our People Operations team. All communications with Charlie Health Talent and People Operations professionals will only be sent from @charliehealth.com email addresses. Legitimate emails will never originate from gmail.com, yahoo.com, or other commercial email services.

Recruiting agencies, please do not submit unsolicited referrals for this or any open role. We have a roster of agencies with whom we partner, and we will not pay any fee associated with unsolicited referrals.

At Charlie Health, we value being an Equal Opportunity Employer. We strive to cultivate an environment where individuals can be their authentic selves. Being an Equal Opportunity Employer means every member of our team feels as though they are supported and belong. We value diverse perspectives to help us provide essential mental health and substance use disorder treatments to all young people.

Charlie Health applicants are assessed solely on their qualifications for the role, without regard to disability or need for accommodation.

By clicking "Submit application" below, you agree to Charlie Health's Privacy Policy and Terms of Service.

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