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Remote Utilization Management Jobs (NOW HIRING)

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Consociate Health

Utilization Management Coordinator

IL · On-site +1

$23/hr

The Utilization Management Coordinator reports to the Director of Claims. This position is ... This is a fully remote position. * If work is performed offsite, location must be HIPAA compliant.

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

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All JobsRemote Utilization Management Jobs

Remote Utilization Management information

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$21

$42

$68

How much do remote utilization management jobs pay per hour?

As of Jun 24, 2026, the average hourly pay for remote utilization management in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.

More about Remote Utilization Management jobs
What cities are hiring for Remote Utilization Management jobs? Cities with the most Remote Utilization Management job openings:
What are the most commonly searched types of Utilization Management jobs? The most popular types of Utilization Management jobs are:
What states have the most Remote Utilization Management jobs? States with the most job openings for Remote Utilization Management jobs include:
What job categories do people searching Remote Utilization Management jobs look for? The top searched job categories for Remote Utilization Management jobs are:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in the United States as of June 2026, with employment types broken down into 84% Full Time, 15% Part Time, and 1% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
AVP, Utilization Management

AVP, Utilization Management

Ensemble Health Partners, Inc.

Remote

Full-time

Medical, Retirement

Posted 22 days ago

Ensemble Health Partners rating

6.5

Company rating: 6.5 out of 10

Based on 238 frontline employees who took The Breakroom Quiz

129th of 139 rated financial services

Job description

Thank you for considering a career at Ensemble!
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!
O.N.E Purpose:
  • Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
  • Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
  • Striving for Excellence: Execute at a high level by demonstrating our "Best in KLAS" Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:
By embodying our core purpose of customer obsession, driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare. The Assistant Vice President, Utilization Management provides senior operational leadership for utilization management programs, supporting enterprise strategies focused on regulatory compliance, clinical documentation integrity, and reimbursement optimization. This role partners closely with clinical, operational, and financial leaders to execute utilization management initiatives, reduce preventable denials, and improve care coordination.
The AVP supports the execution of enterprise utilization management strategy, oversees day-to-day operational performance across assigned programs or service lines, and leads managers and senior leaders responsible for utilization review, authorization, and medical necessity processes. This role will include travel, up to 25%.
KEY RESPONSIBILITIES
  • Executes enterprise utilization management strategy aligned with organizational and regulatory requirements
  • Oversees operations including prior authorization, medical necessity review, and concurrent review processes
  • Ensures compliance with CMS, payer, and state regulatory requirements
  • Identifies and mitigates audit, compliance, and reimbursement risks
  • Monitors performance metrics including denial trends and utilization efficiency
  • Drives performance improvement initiatives based on data analysis
  • Collaborates with clinical, case management, and revenue cycle teams to improve documentation and reduce denials
  • Supports implementation and optimization of utilization management technologies and workflows
  • Leads and develops managers and operational leaders
  • Supports succession planning and organizational capability development
  • May be required to perform other job-related duties as requested.
  • Able to travel up to 25% of the time, any may include occasional international travel

EDUCATION AND EXPERIENCE
  • Bachelor's degree or equivalent combination of education and experience
  • Current RN license
  • 10+ years of relevant experience including advanced knowledge of utilization management and healthcare reimbursement
  • 5+ years of people leadership experience
  • Strong executive presence with the ability to project confidence, credibility and authority; able to remain calm & show decisiveness under pressure
  • Exhibits strong strategic and analytical skills with the ability to drive operational improvements
  • Ability to build and maintain relationships with key internal and external stakeholders
  • Ability to effectively lead diverse teams and influence change management in a complex healthcare operations environment
  • Effective communication skills with ability to clearly and succinctly convey information and ideas
  • Demonstrated advanced usage of AI, success in translating AI into Business outcomes, and the ability to move teams from experimentation to scale.

* This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs dictate.
* This position pays between $134,000 - $167,500 based on experience, and is eligible for bonus incentives.
Join an award-winning company
Five-time winner of "Best in KLAS" 2020-2022, 2024-2025
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
Energage Top Workplaces USA 2022-2024
Fortune Media Best Workplaces in Healthcare 2024
Monster Top Workplace for Remote Work 2024
Great Place to Work certified 2023-2024
  • Innovation
  • Work-Life Flexibility
  • Leadership
  • Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:
  • Associate Benefits - We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
  • Our Culture - Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
  • Growth - We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
  • Recognition - We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.
Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role's range.
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