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Remote Utilization Review Manager Jobs (NOW HIRING)

Medica

Utilization Review III

$70.20K - $120.40K/yr

The Utilization Review III position is responsible for the review, investigation, and resolution of ... Proficiency in case management systems and Microsoft Office applications. This position is a Remote ...

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

Responsible for the effective and sufficient support of all Utilization Management activities to ... Remote Contract to Hire VIVA is an equal opportunity employer. All qualified applicants have an ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105.34K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... POSITION PURPOSE The Utilization Management Nurse evaluates clinical service requests to ensure ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105.34K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... POSITION PURPOSE The Utilization Management Nurse evaluates clinical service requests to ensure ...

The Meadows

Utilization Review Coordinator

Phoenix, AZ · On-site +1

As the Utilization Review Coordinator, you will develop and implement systems for authorizations ... Payer Management * Obtain and maintain authorization for each patient. Problem-solve issues ...

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

As of Jun 3, 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.

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Remote Utilization Review Manager jobs near you

Remote Utilization Management Physician Reviewer

Oak Street Health, part of CVS Health

Chicago, IL • Remote

$174.07K/yr

Full-time

Posted 2 days ago

Job description

Oak Street Health, part of CVS Health, is seeking a Full-Time Utilization Management Physician Reviewer to ensure accurate coverage determinations for inpatient and outpatient services. This role requires at least one year of Utilization Management experience in Medicare/Medicaid, a clinical license in the U.S., and effective communication skills. The position supports personalized primary care for older adults, emphasizing on quality care.

The typical pay range for this role is between $174,070 and $374,920 annually and includes comprehensive benefits. #J-18808-Ljbffr

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