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Remote Utilization Review Jobs (NOW HIRING)

Mercy

Remote - Utilization Review Nurse PRN

Care Management or Utilization Review experience, Preferred Certifications: Case Management or Utilization Review, Preferred Why Mercy? From day one, Mercy offers outstanding benefits - including ...

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

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 ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

Village Care

Utilization Review Nurse

Manhattan, NY · Remote

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - NY, NJ, or CT COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

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How much do remote utilization review jobs pay per hour?

As of Jun 25, 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 are the key skills and qualifications needed to thrive in the Remote Utilization Review position, and why are they important?

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.

What does a typical day look like for someone in a Remote Utilization Review role?

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 is a Remote Utilization Review job?

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.

More about Remote Utilization Review jobs
What cities are hiring for Remote Utilization Review jobs? Cities with the most Remote Utilization Review job openings:
What are the most commonly searched types of Utilization Review jobs? The most popular types of Utilization Review jobs are:
What states have the most Remote Utilization Review jobs? States with the most job openings for Remote Utilization Review jobs include:
What job categories do people searching Remote Utilization Review jobs look for? The top searched job categories for Remote Utilization Review jobs are:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in the United States as of June 2026, with employment types broken down into 84% Full Time, 3% Part Time, and 13% Contract. Highlights an 2% In-person, and 98% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Remote - Utilization Review Nurse PRN

Remote - Utilization Review Nurse PRN

Mercy

Remote

Part-time

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Mercy rating

6.7

Company rating: 6.7 out of 10

Based on 201 frontline employees who took The Breakroom Quiz

522nd of 875 rated healthcare providers

Job description

Find your calling at Mercy!
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 quality patient care, safety and financial components; promoting integration of a seamless care model; assisting with patient throughput; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practice
Position Details:
Qualifications
Education: Graduate of an accredited school of nursing.
Licensure: Current license in the state of residence and/or employment
Experience: 2-3 years acute care hospital setting
Other: Must have the ability to work independently and meet deadlines, giving attention to detail and follow up.
Excellent time management skills, organizational skills, able to coordinate multiple tasks and prioritize work.
Must have a good understanding of medical terminology with the ability to read, discuss and understand patient medical information.
Excellent verbal and written communication skills, particularly telephone
Advanced computer skills and have the ability to interact effectively with a variety of people and situations at all levels of the organization.
Preferred Experience: Care Management or Utilization Review experience,
Preferred Certifications: Case Management or Utilization Review, Preferred
Why Mercy?
From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.

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About Mercy

Sourced by ZipRecruiter

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service. At Mercy, we believe in careers that match the unique gifts of unique individuals - careers that not only make the most of your skills and talents, but also your heart.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Chesterfield, MO, US

Year founded

1827

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