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Remote Utilization Review RN

Detroit, MI · Remote

$35 - $39/hr

Utilization Review RN Contract Duration: 12+ months Job Location: 100% REMOTE License Requirements: MI Registered Nurse License Mandatory Requirements to Apply * Active, unrestricted Michigan ...

Providence Health & Service

Utilization Review RN

Utilization Review RN - Remote Utilization Review RN - REMOTE position. This position is Part time and will work 8-hour, Day shifts. Provide prospective, retrospective, and concurrent utilization ...

Gateway Rehab

Utilization Review Liaison - REMOTE

... utilization reviews, and collaborating with clinical teams and insurance providers to support treatment coverage and reimbursement. This position is fully remote and offers the opportunity to make a ...

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... For positions that are available as remote work, Sentara Health employs associates in the following ...

Emory Healthcare

Utilization Review Specialist

Atlanta, GA · Remote

$47.40 - $54.95/hr

The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough ... Work Type: This position is a remote position outside traditional office, often from home or ...

New

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

Charlie Health

Utilization Review Specialist

Nashville, TN · Remote

$62K - $70K/yr

Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations ... REMOTE Please note that this role is not available to candidates in Alaska, Maine, Washington DC ...

Cobalt Benefits Group

Utilization Review Nurse

Utilization Review Nurse Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse, you'll play an important role in ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

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How much do remote utilization review jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for remote utilization review 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 a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What are the key skills and qualifications needed to thrive in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

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Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in the United States as of September 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Registered Nurse-Utilization Review

Remote

3B Healthcare, Inc.
Health Care and Social Assistance • 51 - 200 employees
Learn more about 3B Healthcare, Inc.external

Other

Re-posted 16 days ago

Job description

Registered Nurse – Utilization Review (Remote)

This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS).

Minimum of 3 years acute medical Care Management/Utilization Review experience in a hospital setting (experience in health plans or medical groups is not applicable).

InterQual experience is mandatory; candidates without this will not be considered.

Proficient in Epic, with recent use within the last 6–12 months.

Experience working with HMOs, IPAs, and similar managed care organizations.

Strong knowledge of Medicare regulations and associated utilization management processes, including:

  • Condition Code 44 (CC44)
  • Advance Beneficiary Notices (ABNs)
  • Hospital-Issued Notices of Noncoverage (HINNs)
  • Medicare Coverage Status Notices (MCSNs)

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