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Remote Utilization Management Jobs (NOW HIRING)

Mercy

Remote - Utilization Review Nurse PRN

Overview Utilization Management for the assigned inpatient Care Management population. This position is designed to facilitate an effective process of the Mercy Care Management model; supporting ...

CHPW

Utilization Management Clinician I

Seattle, WA · On-site +1

$35.92 - $55.67/hr

This position is available fully remote in Washington state. Who we are Community Health Plan of ... About the Role The Level I Utilization Management Clinician performs utilization review for medical ...

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Remote Utilization Management information

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$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.
Utilization Management LPN

Utilization Management LPN

Allmed Staffing Inc

Pearland, TX • Remote

$40/hr

Other

Medical, Dental, Vision, Retirement

Posted 2 days ago

Job description

Job Title: Utilization Management LPN
Allmed Benefits: Vision Insurance, Health Insurance, Dental Insurance and 401(k)
Pay Rate: $40/hr (Paid Weekly)
Work Location: 11511 SHADOW CREEK Pkwy, Pearland, TX
Contract: 05/11/2026 to 08/07/2026
Schedule: Monday – Friday, 8:00 AM – 5:00 PM

Position Overview:

The Utilization Management LPN supports daily utilization management operations by reviewing authorization requests, ensuring timely and accurate processing, and maintaining compliance with health plan and regulatory requirements. This role is essential in supporting workflow efficiency, particularly during periods of increased volume or team coverage needs.

Team Environment:

This position reports to a supervisor and works within a collaborative team of approximately 10–11 members. The team includes licensed nurses and utilization management professionals dedicated to meeting service level agreements, productivity goals, and quality standards in a fast-paced environment.

Key Responsibilities:

  • Review and process authorization requests, including consults, follow-up visits, and procedures
  • Apply medical necessity criteria such as InterQual and evaluate plan benefits
  • Ensure accurate and timely documentation within EPIC or similar systems
  • Communicate authorization decisions and status updates to providers verbally and in writing
  • Maintain compliance with regulatory, quality, and audit requirements
  • Support high-volume work queues and assist with coverage needs
  • Coordinate redirection of services, benefit clarification, and continuity of care
  • Meet established productivity, turnaround time, and quality benchmarks
  • Assist with workflow improvements and departmental goals as needed

Qualifications:

Required:

  • Active LVN/LPN license in a Compact State or Texas
  • Minimum 2 years of clinical experience, preferably in utilization management or managed care
  • Strong knowledge of medical terminology and clinical workflows
  • Experience applying medical necessity criteria such as InterQual
  • Excellent communication, documentation, and organizational skills
  • Ability to multitask, prioritize workload, and meet deadlines

Preferred:

  • Previous Utilization Management or Prior Authorization experience
  • Experience with EPIC and/or IQ Cloud systems
  • Knowledge of Medicare Advantage and Commercial plan requirements
  • Strong understanding of compliance, audits, and regulatory processes
  • Ability to work independently in a remote environment

Additional Information:

  • License Required: Yes – Active LVN/LPN (Compact State or Texas)
  • Dress Code: Business casual (remote-appropriate)
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