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Remote Utilization Review Manager Jobs in Wilson, NC

Smithfield Foods

Strategic Project Manager

Wilson, NC · Remote

This is a remote position with geographic requirements. To effectively support business operations ... You will review and check engineering projects for accuracy and soundness and manage project ...

Coastal Horizons Center

TASC Care Manager

Wilson, NC · Remote

$42K - $45K/yr

Proficiency in using electronic health record systems and remote collaboration tools (i.e., Teams ... We look forward to reviewing your application! EEO STATEMENT Coastal Horizons is an Equal ...

Coastal Horizons Center

TASC Care Manager

Wilson, NC · Remote

$42K - $45K/yr

Proficiency in using electronic health record systems and remote collaboration tools (i.e., Teams ... We look forward to reviewing your application! EEO STATEMENT Coastal Horizons is an Equal ...

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Wilson, NC

Remote Utilization Review Manager information

See Wilson, NC salary details

$34.1K

$79.5K

$146.4K

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

As of Sep 4, 2026, the average yearly pay for remote utilization review manager in Wilson, NC is $79,545.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,000.00 and $95,700.00 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.

What are popular job titles related to Remote Utilization Review Manager jobs in Wilson, NC?

For Remote Utilization Review Manager jobs in Wilson, NC, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in Wilson, NC look for?

The top searched job categories for Remote Utilization Review Manager jobs in Wilson, NC are:

What cities near Wilson, NC are hiring for Remote Utilization Review Manager jobs?

Cities near Wilson, NC with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you

Administrative Physician - Physicians Only Apply - Perm

Oakland Professional Staffing Solutions

Rocky Mount, NC • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 26 days ago

Job description

Medical Doctors Only Apply. A Administrative Physician practice is seeking a qualified physician for NC. This and other physician jobs brought to you by ExactMD.

Utilization Review Physician Advisor-Partial Remote Work Possible-1 Hour from Raleigh

Regional healthcare system in eastern NC, is recruiting a Utilization Review Physician Advisor.  The successful applicant will be a part of the Clinical Documentation Advisor Program, with close working relationship with both Utilization Review (UR) and the Appeals staff. Responsibilities to include status determination and providing guidance for length of stay, resource utilization, compliance, provider education, and clinical documentation.  The advisor must have strong interpersonal and communication skills.  Productivity and compliance metric goals will be required.  The Advisor will report to the UR Physician Advisor Director and will serve as a member of the UR committee. Previous training in regulatory guidance and UR is required.

 Highlights include:

  • Employment
  • Support by a 7-hospital healthcare system
  • Potential for partial remote work
  • Competitive Compensation and Comprehensive Benefit Package to include: Annual CME Stipend, Relocation, Vacation, Malpractice (with tail), 401k matching program/457b, Medical, Dental & Vision & Life Insurance

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