ZipRecruiter

Log In

2

Remote Utilization Management Jobs in New York (NOW HIRING)

HURC

UR Clinical Operations Lead

Short Hills, NJ · Remote

Position Summary The Utilization Review (UR) Clinical lead serves as a subject matter expert in utilization management and hospital revenue cycle operations. This role partners directly with large ...

HURC

UR Clinical Operations Lead

Short Hills, NJ · Remote

Position Summary The Utilization Review (UR) Clinical lead serves as a subject matter expert in utilization management and hospital revenue cycle operations. This role partners directly with large ...

Phaxis

AIMS- REMOTE RN CARE MANAGER

NY · On-site +1

$61 - $63/hr

Knowledge of chronic disease management, utilization management, and patient-centered care ... Experience with telephonic care management or remote patient monitoring. * Familiarity with EHR ...

Winston Medical Staffing

Be Seen First

Utilization Review Nurse

Newark, NJ · Remote

$38 - $40/hr

Position is 100% remote but will have to go to Newark, NJ to pick up equipment and short ... Performs duties and responsibilities assigned by management. Serves as mentor/trainer to new RN's ...

next page

Showing results 1-20

All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in New York

Remote Utilization Management information

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 New York? The most popular types of Utilization Management jobs in New York are:
What are popular job titles related to Remote Utilization Management jobs in New York? For Remote Utilization Management jobs in New York, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in New York look for? The top searched job categories for Remote Utilization Management jobs in New York are:
What cities in New York are hiring for Remote Utilization Management jobs? Cities in New York with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in New York as of July 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 3% In-person, and 97% Remote job distribution.
Utilization Management Nurse Consultant

Utilization Management Nurse Consultant

CVS Health

New York, NY • Remote

$29.10 - $62.32/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,319 frontline employees who took The Breakroom Quiz

88th of 109 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.

UM Nurse Consultant

Fully Remote- WFH

Schedule : Tuesday-Saturday 9:30am-6:00pm

Position Summary:

UM Nurse Consultant

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Required Qualifications

-Must have 3+ years of Med Surg experience as an RN in the hospital setting

- Active and unrestricted RN licensure in state of residence

- Able to work in multiple IT platforms/systems

- 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)

Preferred Qualifications

- Knowledge of Medicare/Medicaid

- Managed care experience

- Utilization Management experience

Education

Associates Degree in Nursing required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$29.10 - $62.32

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 07/29/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

What CVS Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply