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Remote Utilization Management Jobs (NOW HIRING)

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 Nurse

The Utilization Management Nurse 2 work assignments are varied and frequently require ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana

Utilization Management Nurse

The Utilization Management Nurse 2 work assignments are varied and frequently require ... Travel: While this is a remote position, occasional travel to Humana's offices for training 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 Nurse

The Utilization Management Nurse 2 work assignments are varied and frequently require ... Travel: While this is a remote position, occasional travel to Humana's offices for training 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 ...

Humana

Utilization Management Nurse

The Utilization Management Nurse 2 work assignments are varied and frequently require ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana

Utilization Management Nurse

The Utilization Management Nurse 2 work assignments are varied and frequently require ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Honorhealth

Utilization Management Coordinator

Case Management * Remote * 8:30 - 4:00 Great care starts with great people. (Like you.) At ... Job Summary Under the direction of the Network Manager for Utilization Management, assists in the ...

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Remote Utilization Management information

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How much do remote utilization management jobs pay per hour?

As of Aug 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.

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 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 August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Management Registered Nurse

Humana

Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

Humana rating

8.0

Company rating: 8.0 out of 10

Based on 266 frontline employees who took The Breakroom Quiz

167th of 311 rated insurance

Job description

Become a part of our caring community
The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting.

As a Utilization Management Registered Nurse:

  • You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
  • Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers
  • You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?)
  • You will communicate with providers, members, or other parties to facilitate care and treatment.
  • You will help deliver coordinated care for our members
  • You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.

Use your skills to make an impact
Required Qualifications:
  • Must hold Compact Registered Nurse (RN) license in your state of residence
  • Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
  • Must be passionate about contributing to an organization focused on improving consumer experiences
Preferred Qualifications:
  • Previous experience in utilization management/utilization review for a health plan or acute care setting
  • Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
  • Experience working in a fully remote, metrics-focused role
  • Experience as an MDS Coordinator or discharge planner in an acute care setting
  • Experience as an RN for a Medicare Certified Home Health agency
  • Health Plan or Medicare / Medicaid Experience
  • Call center or triage experience
  • BSN or bachelor's degree in a related field
Additional InformationWork-at-Home Information:

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.
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
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.

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.


$71,100 - $97,800 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.
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

Workplace

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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

Social media

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