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Remote Utilization Management Jobs (NOW HIRING)

Intus, Inc

Contract Utilization Management Nurse

$42/hr

Role Overview The Contract Utilization Management Nurse plays a critical role in ensuring high ... This is a fully remote role based in the United States. Sponsorship: This position is not eligible ...

Intus Care

Contract Utilization Management Nurse

$42/hr

Contract Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically ... This is a fully remote role based in the United States. Sponsorship: This position is not eligible ...

INTUS INC

Contract Utilization Management Nurse

$42/hr

Role Overview The Contract Utilization Management Nurse plays a critical role in ensuring high ... This is a fully remote role based in the United States. Sponsorship: This position is not eligible ...

KYYBA

Be Seen First

Remote Utilization Review RN

Detroit, MI · Remote

$35 - $39/hr

Utilization Review RN Contract Duration: 12+ months Job Location: 100% REMOTE License Requirements ... Minimum 5 years of healthcare experience . * 3-5 years of Utilization Management experience ...

Humana

Utilization Management Registered Nurse

As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... Experience working in a fully remote, metrics-focused role * Experience as an MDS Coordinator or ...

Humana

Utilization Management Registered Nurse

As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... Experience working in a fully remote, metrics-focused role * Experience as an MDS Coordinator or ...

Humana

Utilization Management Registered Nurse

As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... Experience working in a fully remote, metrics-focused role * Experience as an MDS Coordinator or ...

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Remote Utilization Management information

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How much do remote utilization management jobs pay per hour?

As of Sep 12, 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.

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.

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 are popular job titles related to Remote Utilization Management jobs?

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

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, and 2% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Management Specialist

Baltimore, MD • Remote

System One
Business Consulting Services • 5 - 10K employees
Learn more about System Oneexternal

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 22 days ago

Job description

Utilization Management Specialist (UM / Utilization Review Nurse) — Remote

Location: 100% Remote (U.S.) — Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension) Schedule: Mon–Fri, 8:00am–5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am–9:00am ET Pay (W2): USD 51.00/H

Job overview

In this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You’ll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.

What you’ll do

  • Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).
  • Make medical necessity / appropriateness determinations and support prior authorizations.
  • Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines).
  • Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines.
  • Research diagnoses/treatments and high-cost services; summarize findings and escalate complex cases to Medical Directors as needed.
  • Collaborate with internal partners and providers to support benefit application and appropriate levels/settings of care.
  • Maintain accurate documentation and protect PHI while managing a busy caseload.

Required qualifications

  • Active RN or LPN license (RN preferred) — Maryland compact/eligibility required
  • 5+ years clinical nursing experience
  • 2+ years care management / utilization management experience
  • MCG experience (required)
  • Experience supporting Commercial/FEP/Medicare lines of business and applying medical policy/regulatory standards
  • Strong critical thinking, written communication, and ability to work independently in a remote setting
  • Comfortable with web-based tools + Microsoft Office (Word/Excel/PowerPoint)
  • Guiding Care and FACETS (required)

Nice to have

  • Critical Care or ER clinical background
  • Experience with LCD/NCD, Medicare guidelines, ASAM, or other authorization criteria sets

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1

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About System One

Sourced by ZipRecruiter

System One helps employers get work done more efficiently and economically without compromising quality. Over our 35+ year history, we've helped connect thousands of talented people with innovative companies. The excitement of a perfect fit motivates us every single day.

Industry

Business consulting services and recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Pittsburgh, PA, US

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