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Remote Utilization Management Jobs in New Jersey

Med-Metrix

Physician Advisor - Remote

Parsippany, NJ · On-site +1

Provides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization ...

Hurc LLC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

Bcbsa

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Monogram Health

Market Physician Executive

Trenton, NJ · Remote

This position will be remote within the designated market with occasional in-home patient treatment ... medical utilization management, and risk adjustment. * Current state medical license without ...

Monogram Health

Market Physician Executive

Newark, NJ · Remote

This position will be remote within the designated market with occasional in-home patient treatment ... medical utilization management, and risk adjustment. * Current state medical license without ...

ACHIEVE TEST PREP

Lead PMO - Remote

Newark, NJ · On-site +1

Lead a team of project managers to support them in standardizing projects, integrating best ... Work closely with the IT department to ensure effective utilization and prioritization of ...

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Remote Utilization Management information

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$21

$42

$70

How much do remote utilization management jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for remote utilization management in New Jersey is $42.93, according to ZipRecruiter salary data. Most workers in this role earn between $33.94 and $49.28 per hour, depending on experience, location, and employer.

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 are the key skills and qualifications needed to thrive in remote utilization management?

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.

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 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 New Jersey?

The most popular types of Utilization Management jobs in New Jersey are:

What are popular job titles related to Remote Utilization Management jobs in New Jersey?

For Remote Utilization Management jobs in New Jersey, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management jobs in New Jersey look for?

The top searched job categories for Remote Utilization Management jobs in New Jersey are:

What cities in New Jersey are hiring for Remote Utilization Management jobs?

Cities in New Jersey with the most Remote Utilization Management job openings:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in New Jersey as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 2% Temporary, and 3% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $89,286 per year, or $42.9 per hour.

Outcomes Manager - UR (Per Diem)

VIRTUA HEALTH

Pennsauken, NJ • Remote

$38.33 - $59.58/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 18 days ago

Virtua Health rating

7.7

Company rating: 7.7 out of 10

Based on 175 frontline employees who took The Breakroom Quiz

159th of 893 rated healthcare providers

Job description

At Virtua Health, we exist for one reason - to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between - we are your partner in health devoted to building a healthier community.
If you live or work in South Jersey, exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment.
In addition to five hospitals, seven emergency departments, seven urgent care centers, and more than 280 otherlocations, we're committed to the well-being of the community. That means bringing life-changing resources and health services directly into our communities through ourEat Well food access program, telehealth, home health, rehabilitation, mobile screenings, paramedic programs, and convenient online scheduling. We're also affiliated with Penn Medicine for cancer and neurosciences, and the Children's Hospital of Philadelphia for pediatrics.

Location:

Pennsauken - 6991 North Park Dr.

Remote Type:

100% Remote

Employment Type:

Employee

Employment Classification:

Per Diem

Time Type:

Part time

Work Shift:

1st Shift (United States of America)

Total Weekly Hours:

0

Additional Locations:

Job Information:

Summary:
Responsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes.
Acts as a resource to other team members including UR Tech and AA to support UR and revenue cycle process.
Position Responsibilities:
Utilization Management
Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.
Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
Documentation
Appropriate and complete documentation of clinical review and denial management in the case management documentation system and in the billing system.
Denial Management
Manages the concurrent denial process by referring to appropriate resource for concurrent and retrospective appeal activity process.
Prepares and facilitates audits using appropriate screening tools and documentation.
Metrics
Accountable to job specific goals, objectives and dashboards which contribute to the success of the organization.
Participates in organizational improvement activities including patient satisfaction, Six Sigma committee, department and/or divisional teams and community activities.
Compliance
Understands and applies applicable federal and state requirement.
Identify and reports compliance issues as appropriate.
Position Qualifications Required / Experience Required:
Preferred: 3 years clinical nursing (RN) experience and 1 year UR/CM/QM experience or 3 years experience as Clinical Social Worker.
Basic understanding of Medicare, Medicaid and managed care.
Discharge planning or home health background.
Excellent verbal and written communication skills, problem solving, critical thinking and conflict resolution.
Required Education:
Graduate of an accredited School of Nursing.
Training/Certifications/Licensure:
Licensure from the State of New Jersey as a Registered Nurse.
Case Management Certification (requirement within one year of hire beginning April 1, 2015).
STAR Standards: Exhibits Virtua's STAR Standards to create an outstanding patient experience. (Excellent Service, Clinical Quality and Safety, Best People, Caring Culture, Resource Stewardship).
Demonstrates Virtua values in all interactions with our customers, who are patients, families, physicians, co-workers and the community. (Integrity, Respect, Caring, Commitment, Teamwork, Excellence).

Hourly Rate: $38.33 - $59.58 The actual salary/rate will vary based on applicant's experience as well as internal equity and alignment with market data.Virtua offers a comprehensive package of benefits for full-time and part-time colleagues, including, but not limited to: medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave as provided under state and local paid sick leave laws, short-term disability and optional long-term disability, colleague and dependent life insurance and supplemental life and AD&D insurance; tuition assistance, and an employee assistance program that includes free counseling sessions. Eligibility for benefits is governed by the applicable plan documents and policies.

For more benefits information click here.

What Virtua Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Virtua Health logo

About Virtua Health

Sourced by ZipRecruiter

At Virtua Health, we exist for one reason - to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between - we are your partner in health devoted to building a healthier community. If you live or work in South Jersey, exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment. In addition to five hospitals, seven emergency departments, seven urgent care centers, and more than 280 other locations, we're committed to the well-being of the community. That means bringing life-changing resources and health services directly into our communities through our Eat Well food access program, telehealth, home health, rehabilitation, mobile screenings, paramedic programs, and convenient online scheduling. We're also affiliated with Penn Medicine for cancer and neurosciences, and the Children's Hospital of Philadelphia for pediatrics.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Marlton, NJ, US

Year founded

1998

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