ZipRecruiter

Log In

2

Remote Utilization Review Manager Jobs (NOW HIRING)

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

As a Manager, Utilization Review, you will hire, evaluate, and supervise Utilization Review ... This position is posted as remote; however, per company policy, candidates residing within a ...

New

Dane Street, LLC

Utilization Review Physician

Ability to manage short-TAT and urgent cases efficiently * Clear, audit-ready documentation ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

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 ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

next page

Showing results 1-20

People also search for

All JobsRemote Utilization Review Manager Jobs

Remote Utilization Review Manager information

See salary details

$39K

$91K

$167.5K

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

As of May 31, 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 are the key skills and qualifications needed to thrive as a Remote Utilization Review Manager, and why are they important?

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 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 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.

More about Remote Utilization Review Manager jobs
What cities are hiring for Remote Utilization Review Manager jobs? Cities with the most Remote Utilization Review Manager job openings:
What are the most commonly searched types of Remote Utilization Review jobs? The most popular types of Remote Utilization Review jobs are:
What states have the most Remote Utilization Review Manager jobs? States with the most job openings for Remote Utilization Review Manager jobs include:
What job categories do people searching Remote Utilization Review Manager jobs look for? The top searched job categories for Remote Utilization Review Manager jobs are:
Remote Utilization Review Manager jobs near you

Remote Utilization Review RN - RURR 26-06086

NavitasPartners

Healdsburg, CA • Remote

$40 - $45/hr

Other

Posted 5 days ago

Job description

Job Title: Remote Utilization Review RN

Location: Santa Rosa, CA
Assignment Duration: 13 Weeks
Schedule: Day Shift - 5x8 Hours (8:00 AM - 4:30 PM)

Compensation:
  • Pay Rate: $40-$45/hr based on experience
Position Overview:

We are seeking an experienced Remote Utilization Review Registered Nurse (RN) to support healthcare operations by ensuring the appropriate use of medical services and resources. The ideal candidate will have strong knowledge of medical necessity criteria, payer guidelines, and utilization review processes while working collaboratively with interdisciplinary healthcare teams.

Responsibilities:
  • Perform utilization review activities to ensure appropriate and cost-effective use of healthcare resources
  • Review patient medical records for medical necessity and compliance with payer requirements
  • Collaborate with physicians, case managers, and interdisciplinary healthcare teams
  • Submit, track, and monitor authorizations, approvals, and denials
  • Maintain accurate, timely, and compliant documentation
  • Ensure adherence to healthcare regulations and payer guidelines
  • Communicate effectively with providers and healthcare staff regarding review outcomes
  • Support quality improvement initiatives related to utilization management
Qualifications:
  • Active Registered Nurse (RN) License
  • Recent Utilization Review experience preferred
  • Strong understanding of payer guidelines and medical necessity criteria
  • Excellent communication, critical thinking, and organizational skills
  • Ability to work independently in a remote environment
  • Strong documentation and computer skills
  • Ability to manage multiple tasks in a fast-paced healthcare setting

For more details reach at Aditi.sharma@navitashealth.com or Call / Text at 516-587-6677.

About Navitas Healthcare, LLC: It is a certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

Apply