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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 ... Minimum 5 years of healthcare experience . * 3-5 years of Utilization Management experience ...

Gateway Rehab

Utilization Review Liaison - REMOTE

Attend managed care provider meetings as needed. * Participate in required GRC trainings and in ... Strong understanding of utilization review, insurance authorization processes, and managed care ...

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 ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

This position is responsible for performing initial, concurrent review activities; discharge care ... Utilization management experience LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin ...

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How much do remote utilization review manager jobs pay per year?

As of Sep 10, 2026, the average yearly pay for remote utilization review manager in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 per year, depending on experience, location, and employer.

What is a remote utilization review manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a remote utilization review manager?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a remote utilization review manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

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Remote Utilization Review Manager jobs near you

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 12 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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