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Remote Utilization Management Jobs in Nevada (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Las Vegas, NV · On-site +1

$51.50 - $62.75/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Deloitte

Epic Tapestry Consultant

Las Vegas, NV · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Strong desktop skills including Word, Excel, PowerPoint * Work ...

Deloitte

Epic Tapestry Specialist

Las Vegas, NV · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Ability to work independently and collaborate as part of a team

Deloitte

Epic Tapestry Sr Analyst

Las Vegas, NV · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Analytical/ Decision Making Responsibilities * Analytical ability to ...

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How much do remote utilization management jobs pay per hour?

As of Jun 14, 2026, the average hourly pay for remote utilization management in Nevada is $43.06, according to ZipRecruiter salary data. Most workers in this role earn between $34.04 and $49.42 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 Nevada? The most popular types of Utilization Management jobs in Nevada are:
What are popular job titles related to Remote Utilization Management jobs in Nevada? For Remote Utilization Management jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Nevada look for? The top searched job categories for Remote Utilization Management jobs in Nevada are:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Nevada as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $89,556 per year, or $43.1 per hour.
Utilization Management Manager REMOTE Full Time

Utilization Management Manager REMOTE Full Time

ScionHealth

Las Vegas, NV • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 19 days ago

ScionHealth rating

6.0

Company rating: 6.0 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

728th of 872 rated healthcare providers

Job description

At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.
Job Summary
The Utilization Management Manager plays a vital role in ensuring patients have timely access to care by managing both front-end prior authorizations and in-house concurrent review authorizations. This position blends strong relationship-building skills with clinical knowledge to navigate complex payer requirements, streamline the authorization process, and support seamless patient transitions.
From start to finish, this role drives the authorization process-reviewing prospective, retrospective, and concurrent medical records; coordinating with referring hospitals to secure prior authorizations; and partnering with case management teams at ScionHealth facilities to complete concurrent review authorizations. Acting as a navigator and liaison between Business Development, facility administration, managed care organizations, and payors, the specialist ensures determinations are communicated promptly and accurately to all relevant stakeholders.
By combining attention to detail with proactive collaboration, the Utilization Management Manager safeguards revenue integrity, reduces delays, and supports the organization's mission of delivering exceptional patient care. This role actively contributes to quality improvement, problem-solving, and productivity initiatives within an interdisciplinary model, demonstrating accountability and a commitment to operational excellence.
Essential Functions
  • Extrapolates and summarizes essential medical information to obtain authorization for admission and continued stay to/at ScionHealth Level of Care.
  • Prepares recommendations to sumbit timely request for reconsideration of denial determination in attempt to have denied authorization requests overturned.
  • Ensures authorization requests are processed timely to meet regulatory timeframes.
  • Reviews medical necessity assessments completed by case management, evaluating documentation for specific criteria related to severity of illness, and level of care appropriateness.
  • Generates written appeals to medical necessity-based payor denials for denials prior to admission and concurrent review authorizations. Appeal letters may be processed on behalf of the physician, combining clinical and regulatory knowledge in efforts to have consideration of authorization.
  • Documents authorization information in relevant tracking systems.
  • Effectively builds relationships with business development team, admissions team/clinical staff and managed care team, to coordinate the patient admission functions in keeping with the mission and vision of the hospital.
  • Supports review of patient referral for clinical and financial approval and/or escalation to leadership for approval following the Care Considerations grid.
  • Coordinates and facilitates pre-admission Prior Authorizations for patients from the referral sources:
    • Identifies /reviews medical record information needed from referring facility.
    • Applies appropriate clinical guidelines to pre-authorization determination process.
    • Communicates specific patient needs for equipment, supplies, and consult services as related to prior authorization requirements.
    • Acts as a liaison with the Business Development team through every stage of the authorization process through determination.
    • Initiates appeals process as appropriate.
    • Facilitates and coordinates physician-to-physician communication as appropriate to support the denial management process.
    • Communicates to appropriate teams, including business development and facility administration when clinical authorization and financial approval is complete, following standard authorization process.
  • Provides hospital team with needed prior authorization information on pending / new admissions.
  • Coordinate with managed care payor on all coverage issues and supports the LOA process as requested.
  • Coordinates and facilitates Concurrent Review Authorizations for patients actively in-house at a ScionHealth facility
    • Identifies /reviews medical record information needed from facility.
    • Applies appropriate clinical guidelines to concurrent review authorization process.
    • Review medical necessity review information provided by the case management team and communicates any additinoal questions or information requests
    • Acts as a liaison with the Case Management team through every stage of the concurrent review authorization process through determination.
    • Initiates appeals process as appropriate.
  • Communicates with Medical Advisors or case managers of managed care company as necessary; including during Care Coordination / Managed Care calls
  • Maintains a knowledge of areas of responsibility and develops and follows a program of continuing education.
  • Participates in continuing education/ professional development activities.
  • Learns and develops full knowledge of the CAAT Admission Processes and actively seeks to continuously improve them.

Knowledge/Skills/Abilities/Expectations
  • Strong relationship building skills and a spirit to serve to ensure effective communication and service excellence.
  • Knowledge of regulatory standards and compliance guidelines.
  • Working knowledge of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare and Medicaid rules, regulations, coverage guidelines, NCDs and LCDs.
  • Working knowledge of Medicare, Medicaid and Managed Care payment and methodology.
  • Extensive knowledge of clinical symptomology, related treatments and hospital utilization management.
  • Excellent interpersonal, verbal and written skills to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers.
  • Critical thinking, problem solving, and decision-making capabilities with the ability to discern, collect, organize, evaluate, and communicate pertinent clinical information with effective verbal and written skills.
  • Technical writing skills for appeal letters and reports.
  • Effective time management and prioritization skills.
  • Computer skills with working knowledge of Microsoft Office (Word, Excel, PowerPoint, and Outlook), word-processing and spreadsheet software.
  • Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
  • Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
  • Communicates and demonstrates a professional image/attitude for patients, families, clients, coworkers and others.
  • Adheres to policies and practices of ScionHealth.
  • Must read, write, and speak fluent English
  • Must have good and regular attendance.
  • Approximate percent of time required to travel: N/A

Pay Range: $66,700-$100,500/yr
ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness.
Qualifications
Education
  • Postsecondary non-Degree (Cert/Diploma/Program Grad) of an Accredited School of Nursing required
  • Associate's Degree in healthcare or related field required
  • Bachelor's Degree in healthcare or related field preferred
  • Equivalent combination of Education and/or Experience in lieu of education (3+ years in a related field) may be considered.

Licenses/Certifications
  • Healthcare professional licensure preferred.
  • In lieu of licensure, 3+ years of experience in relevant field required.
  • Some states may require licensure or certification.

Experience
  • 3+ years of experience in a healthcare strongly preferred.
  • Experience in managed care, case management, utilization review, or discharge planning a plus.

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