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Remote Utilization Management Jobs in Kentucky (NOW HIRING)

Humana

Director, Technology Solutions

Louisville, KY · On-site +1

Support healthcare operations including Utilization Management (UM), Care Management (CM), HEDIS ... This position's work style is remote from any of the locations listed below. You must reside in ...

Humana

Director, Technology Solutions

Louisville, KY · On-site +1

Support healthcare operations including Utilization Management (UM), Care Management (CM), HEDIS ... This position's work style is remote from any of the locations listed below. You must reside in ...

Humana

Director, Technology Solutions

Louisville, KY · On-site +1

Support healthcare operations including Utilization Management (UM), Care Management (CM), HEDIS ... This position's work style is remote from any of the locations listed below. You must reside in ...

ITW

National Sales Manager

Louisville, KY · Remote

The role is a remote position; location base will be reviewed as this position covers all regions ... Develop communication and territory management skills throughout the field sales team * Identify ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Kentucky

Remote Utilization Management information

See Kentucky salary details

$18

$36

$59

How much do remote utilization management jobs pay per hour?

As of Jun 15, 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

(RN) Care Review Clinician - Weekend Role (REMOTE)

Passport Health Plan by Molina Healthcare

Louisville, KY • Remote

$25.08 - $51.49/hr

Full-time

Posted 6 hours ago

Job description

 Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. The schedule for this role includes holidays and weekends. 


Essential Job Duties 
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
Processes requests within required timelines. 
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
Requests additional information from members or providers as needed. 
Makes appropriate referrals to other clinical programs. 
Collaborates with multidisciplinary teams to promote the Molina care model. 
Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
Registered Nurse (RN). License must be active and unrestricted in state of practice. 
Ability to prioritize and manage multiple deadlines. 
Excellent organizational, problem-solving and critical-thinking skills. 
Strong written and verbal communication skills. 
Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
Certified Professional in Healthcare Management (CPHM). 
Recent hospital experience in an intensive care unit (ICU) or emergency room. 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $25.08 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

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