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Remote Utilization Management Jobs in Kentucky (NOW HIRING)

UK St Claire

Utilization Review Nurse

Morehead, KY · On-site +1

Supports utilization review processes by planning, analyzing data, and setting goals to ensure ... Case Management Shift : Days (United States of America) Time Type: Full time Address : 222 Medical ...

Lifepoint Health

Claims Analyst- Remote

Louisville, KY · On-site +1

Days: M-F Job Location Type: [ Remote] Your experience matters At Lifepoint Health, we are ... Collaborate with Utilization Management departments to ensure pre-certifications, authorizations ...

Cayenta

(Remote) Application Consultant

Canada, KY · Remote

Work with colleagues and managers to implement and proactively manage superior utility CIS ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

Harris

(Remote) Application Consultant

Canada, KY · Remote

Work with colleagues and managers to implement and proactively manage superior utility CIS ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

Harris

(Remote) Application Consultant

Canada, KY · Remote

Work with colleagues and managers to implement and proactively manage superior utility CIS ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

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Remote Utilization Management information

See Kentucky salary details

$18

$36

$59

How much do remote utilization management jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for remote utilization management in Kentucky is $36.72, according to ZipRecruiter salary data. Most workers in this role earn between $29.04 and $42.16 per hour, depending on experience, location, and employer.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Kentucky? The most popular types of Utilization Management jobs in Kentucky are:
What are popular job titles related to Remote Utilization Management jobs in Kentucky? For Remote Utilization Management jobs in Kentucky, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Kentucky look for? The top searched job categories for Remote Utilization Management jobs in Kentucky are:
What cities in Kentucky are hiring for Remote Utilization Management jobs? Cities in Kentucky with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Kentucky as of July 2026, with employment types broken down into 92% Full Time, and 8% Contract. Highlights an 100% Remote job distribution, with an average salary of $76,384 per year, or $36.7 per hour.
Utilization Management RN (Discharge & Auth) Weekends Required

Utilization Management RN (Discharge & Auth) Weekends Required

Humana

Louisville, KY • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Humana rating

7.9

Company rating: 7.9 out of 10

Based on 262 frontline employees who took The Breakroom Quiz

174th of 299 rated insurance

Job description

Become a part of our caring community
The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. This role has primary responsibility for performing medical necessity reviews, including initial and concurrent authorization decisions, using established clinical criteria and independent clinical judgment. The Utilization Management Nurse 2 also plays a key role in facilitating comprehensive, proactive, and barrier-focused discharge planning to home or a lower level of care.

The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.

  • Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
  • Maintain compliance with state regulations and organizational standards for coordinated member discharge, ensuring all plans are documented and communicated effectively.
  • Perform initial and concurrent reviews with medical necessity determinations, including level of care and length of stay decisions.
  • Engage providers via telephonic, virtual, and onsite collaboration as needed.
  • Follows established guidelines/procedures.

The schedule for this position will include weekends, typically Wednesday through Sunday from 8:00 AM to 5:00 PM Eastern Time with flexibility to adjust weekdays off with leader approval.


Use your skills to make an impact

Required Qualifications

  • Licensed Registered Nurse (RN) in the state of Kentucky, in good standing with no disciplinary action.

  • 2+ years of progressive clinical experience in an acute care, skilled nursing, or rehabilitation setting (preferred).

  • 1+ year of utilization management experience.

  • Maintain compliance with state regulations and organizational standards, ensuring that we coordinate and document member discharge plans and communicate them.

  • Experience performing initial and concurrent reviews for medical service requests, with the ability to interpret clinical criteria and apply judgment to support appropriate use and benefit administration.

  • Experience engaging with providers and care teams through telephonic, virtual, or onsite interactions to facilitate authorizations and support member-centered discharge planning.

  • Strong proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.

Preferred Qualifications

  • Bachelor's degree in nursing.

  • MCG experience.

  • Experience in discharge planning, transitions of care, and familiarity with community-based resources and social determinants of health.

  • Health plan experience.

  • Medicaid experience.

  • Bilingual in English and another language. A Language Proficiency Assessment will be conducted to evaluate fluency in reading, writing, and speaking in both languages prior to assignment to a dedicated member service line.

Additional Information

Workstyle: Remote work at home

Location: Must reside in Kentucky or a county that is within contiguous bordering states

Schedule: The schedule for this position will include weekends (Weekend shifts are eligible for a shift differential), from 8:00 AM to 5:00 PM Eastern Time with flexibility to adjust weekdays off with leader approval:

  • The position follows a 5-day workweek, which includes both Saturday and Sunday.
  • Associates will receive two days off during the week.
  • Associates may choose which two weekdays they would like off.
  • Once selected, those days off must remain consistent from week to week and cannot vary.

Travel: Travel to the Louisville office about 3-4 times annually.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$71,100 - $97,800 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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About Humana

Sourced by ZipRecruiter

Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Louisville, KY, US

Year founded

1961

Social media

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