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Remote Utilization Management Jobs (NOW HIRING)

Humana

Manager, Utilization Management Nursing

Utilization management * Prior experience within discharge planning, case management * Health Plan ... Remote work at Home Location: Reside in a state participating in a compact license, (eNLC) Schedule:

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 ...

Centene

Supervisor, Utilization Management (RN)

$75K - $135K/yr

Collaborates with utilization management team to resolve complex care member issues * Maintains ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

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

Manager, Utilization Management Nursing

Utilization management * Prior experience within discharge planning, case management * Health Plan ... Remote work at Home Location: Reside in a state participating in a compact license, (eNLC) Schedule:

Humana

Manager, Utilization Management Nursing

Utilization management * Prior experience within discharge planning, case management * Health Plan ... Remote work at Home Location: Reside in a state participating in a compact license, (eNLC) Schedule:

KYYBA

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 ...

Devoted Health

Utilization Management Coordinator

$21.70 - $27/hr

The Utilization Management Coordinator plays a vital role in supporting Clinical Operations by ... This is a full-time, remote position working five 8-hour days per week. Shifts are scheduled ...

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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 5, 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.

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Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Manager, Utilization Management Nursing

Humana

Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted yesterday

Humana rating

8.0

Company rating: 8.0 out of 10

Based on 267 frontline employees who took The Breakroom Quiz

172nd of 315 rated insurance

Job description

Become a part of our caring community
The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

The Manager, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.


Use your skills to make an impact

Required Qualifications

  • Active Licensed Registered Nurse (RN) in Virginia or enhanced compact license, (eNLC) with no disciplinary action
  • Minimum 2 years of team lead and/or project lead experience
  • Minimum 2 years progressive clinical experience preferably in an acute care, skilled or rehabilitation setting
  • Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
  • Ability to work independently under general instructions and with a team

Preferred Qualifications

  • Bachelor's Degree
  • Prior supervisory experience which may include interviewing, hiring, training, performance evaluation, coaching and up to termination.
  • Utilization management
  • Prior experience within discharge planning, case management
  • Health Plan experience
  • Prior Medicare / Medicaid experience
  • Call center or triage experience
  • Bilingual is a plus

Workstyle: Remote work at Home

Location: Reside in a state participating in a compact license, (eNLC)

Schedule: Must work a minimum of 8 hours between 8:00 AM to 5:00 PM Eastern Time, may be required to work rotating holidays or weekends as determined by business needs

Travel: Less than 10 % for onsite market as business needs

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Florida Background Screening Requirements: Notice for candidates applying to this position from a Florida work location, including Florida home-based work location. This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse. For information about the screening process and requirements, visit: https://info.flclearinghouse.com.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$94,900 - $130,500 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 09-04-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

What Humana employees say

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Benefits

Hours and flexibility

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About Humana

Sourced by ZipRecruiter

Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Louisville, KY, US

Year founded

1961

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