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Remote Utilization Management Nurse Jobs (NOW HIRING)

Humana

Utilization Management Nurse

As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well ... This is a remote position supporting members and providers throughout Illinois with periodic in ...

Humana

Utilization Management Nurse

As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well ... This is a remote position supporting members and providers throughout Illinois with periodic in ...

Humana

Utilization Management Nurse

As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well ... This is a remote position supporting members and providers throughout Illinois with periodic in ...

Cottingham & Butler

Utilization Management Nurse

Utilization Management Nurse We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, and prefers working in a ...

CVS Health

Utilization Management Nurse Consultant

$26.01 - $62.32/hr

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule Are you a Registered Nurse ready to make an impact beyond the bedside? Join our ...

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Remote Utilization Management Nurse information

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

As of Sep 3, 2026, the average hourly pay for remote utilization management nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.

More about Remote Utilization Management Nurse jobs

What cities are hiring for Remote Utilization Management Nurse jobs?

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Remote Utilization Management Nurse jobs near you
Infographic showing various Remote Utilization Management Nurse job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Registered Nurse-Utilization Review

3B Healthcare, Inc.

Remote

Other

This job post has expired 3 days ago. Applications are no longer accepted.

Job description

Registered Nurse – Utilization Review (Remote)

This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS).

Minimum of 3 years acute medical Care Management/Utilization Review experience in a hospital setting (experience in health plans or medical groups is not applicable).

InterQual experience is mandatory; candidates without this will not be considered.

Proficient in Epic, with recent use within the last 6–12 months.

Experience working with HMOs, IPAs, and similar managed care organizations.

Strong knowledge of Medicare regulations and associated utilization management processes, including:

  • Condition Code 44 (CC44)
  • Advance Beneficiary Notices (ABNs)
  • Hospital-Issued Notices of Noncoverage (HINNs)
  • Medicare Coverage Status Notices (MCSNs)

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