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Remote Utilization Review Nurse Practitioner Jobs

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ...

CoxHealth

Registered Nurse - Utilization Review

Remote Missouri: 1423 North Jefferson Avenue, Springfield, Missouri, United States of America ... Benefits | CoxHealth The Utilization Review Nurse RN collaborates with the physician and members of ...

Dane Street

PRN Utilization Review Nurse Reviewer

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring ... Apple equipment and a media stipend are provided for remote workspace. ABOUT DANE STREET: A fast ...

Personify Health

Utilization Review Nurse - RN

$30 - $38/hr

Current, unrestricted RN license in the United States or a U.S. territory (compact license accepted ... Utilization review/utilization management experience preferred Technical Skills: * Proficiency with ...

Astrana Health, Inc.

UM Review Nurse

$34 - $47/hr

... Utilization Review Nurse to assist our Health Services Department. In this position, you will ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

CommonSpirit Health

Utilization Review RN

The Utilization Review RN is responsible for the review of medical records for appropriate ... This position is open to remote/out of state candidates residing in only these states: Alabama ...

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Remote Utilization Review Nurse Practitioner information

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$71K

$134.4K

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How much do remote utilization review nurse practitioner jobs pay per year?

As of Aug 9, 2026, the average yearly pay for remote utilization review nurse practitioner in the United States is $134,369.00, according to ZipRecruiter salary data. Most workers in this role earn between $111,000.00 and $152,500.00 per year, depending on experience, location, and employer.

What is the difference between Remote Utilization Review Nurse Practitioner vs Telehealth Nurse Practitioner?

AspectRemote Utilization Review Nurse PractitionerTelehealth Nurse Practitioner
CertificationsNP license, possibly certification in utilization reviewNP license, general telehealth certifications
Work EnvironmentReviewing medical records, insurance data remotelyProviding patient care via telehealth platforms
Employer & IndustryInsurance companies, healthcare organizationsHospitals, clinics, telehealth companies

The main difference is that Remote Utilization Review Nurse Practitioners focus on reviewing medical necessity and insurance claims remotely, while Telehealth Nurse Practitioners provide direct patient care via telehealth platforms. Both roles require NP licensure, but their daily tasks and work environments differ significantly.

What is a remote utilization review nurse practitioner?

A Remote Utilization Review Nurse Practitioner is a licensed advanced practice nurse who evaluates the necessity, efficiency, and appropriateness of healthcare services, treatments, and hospital admissions, typically from a remote or home-based setting. They review patient medical records to ensure care meets established guidelines and insurance requirements, helping to control costs and ensure quality care. Their role often involves collaborating with physicians, insurance companies, and healthcare facilities to determine coverage and recommend alternative treatments when necessary. Working remotely, they rely heavily on electronic health records and telecommunication tools to perform their duties.

How does a remote utilization review nurse practitioner typically collaborate with healthcare teams while working offsite?

Remote Utilization Review Nurse Practitioners frequently collaborate with interdisciplinary teams through virtual meetings, secure messaging platforms, and electronic health record (EHR) systems. They work closely with physicians, case managers, and insurance representatives to review patient care plans, ensure medical necessity, and support appropriate resource utilization. Despite working remotely, maintaining clear communication and timely documentation is essential for seamless coordination and decision-making. Many organizations provide robust digital tools and regular team check-ins to facilitate collaboration and support remote staff.

What are the key skills and qualifications needed to thrive as a remote utilization review nurse practitioner, and why are they important?

To thrive as a Remote Utilization Review Nurse Practitioner, you need an advanced nursing degree (NP), active state licensure, and strong knowledge of clinical guidelines and insurance criteria. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) are often required. Critical thinking, strong communication, and a detail-oriented approach set top performers apart in this remote role. These skills ensure accurate, compliant, and efficient review of patient care while supporting healthcare cost management and patient advocacy.
More about Remote Utilization Review Nurse Practitioner jobs
What cities are hiring for Remote Utilization Review Nurse Practitioner jobs? Cities with the most Remote Utilization Review Nurse Practitioner job openings:
What states have the most Remote Utilization Review Nurse Practitioner jobs? States with the most job openings for Remote Utilization Review Nurse Practitioner jobs include:
What job categories do people searching Remote Utilization Review Nurse Practitioner jobs look for? The top searched job categories for Remote Utilization Review Nurse Practitioner jobs are:
Remote Utilization Review Nurse Practitioner jobs near you
Infographic showing various Remote Utilization Review Nurse Practitioner job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $134,369 per year, or $64.6 per hour.

Utilization Review Nurse

University of Utah Health

Murray, UT • On-site, Remote

Full-time

Re-posted 20 days ago

University Of Utah Health rating

7.7

Company rating: 7.7 out of 10

Based on 142 frontline employees who took The Breakroom Quiz

159th of 887 rated healthcare providers

Job description

Overview
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA
This position is responsible for maintaining the financial integrity of both the patient and the organization through the provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such care; achieved via managing the cost of care while providing timely and accurate information to third party payers and medical care team. This position may be required to access and administer medications within their scope of practice and according to state law.
Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.
Responsibilities
Essential Functions
  • Applies approved utilization criteria to monitor appropriateness of admissions with associated levels of care and continued stay review.
  • Communication to third-party payers for initial and concurrent clinical review.
  • Reviews patient chart to ensure patient continues to meet medical necessity.
  • Documentation of all actions and information shared with care team members or third-party payer.
  • Alerts and discusses with physician/provider and case manager/discharge planner when patient no longer meets medical necessity criteria for the inpatient stay.
  • Discusses with physicians the appropriateness of resource utilization.
  • Tracks length of stay (LOS) and resource utilization to identify at risk patients.
  • Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources.
  • Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration with the payer per university contractual obligation.
  • Participant in UR Committee as needed.
  • Collects data on variances in LOS, avoidable days, costs/barriers to discharge/transition and denied days.
  • Prepares appeals on denied cases when appropriate.
  • At the discretion of department operational and patient care needs, this position is required to work rotating schedules, which may include variable hours, weekends, nights, and holidays to meet the staffing and patient care demands of a 24/7 complex health system. Regular, reliable, and punctual attendance during assigned shifts is considered an essential function of the role.
Knowledge / Skills / Abilities
  • Demonstrated availability to work variable and rotating shifts, including nights, weekends, and holidays, in a 24/7 patient care environment.
  • Ability to perform the essential functions of the job as outlined above.
  • Demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills.
  • Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria.
  • The ability to demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.
  • Ability to work autonomously and as a team member.

Qualifications
Required
  • One year Utilization Review or Case Management experience.
Licenses Required
  • Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 days of hire under the interstate compact if switching residency to State of Utah. Must maintain current Interstate Compact (multi-state) license if residency is not being changed to Utah.
* Additional license requirements as determined by the hiring department.
Qualifications (Preferred)
Preferred
  • Knowledge of ICD-10, CPT Codes, and medications HCPCS
  • Knowledge of CMS Regulations.
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
  • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions. This position does not provide care to patients.

Physical Requirements
Carrying, Color Determination, Crawling, Far Vision, Lifting, Listening, Manual Dexterity, Near Vision, Pulling and/or Pushing, Reaching, Sitting, Speaking, Standing, Stooping and Crouching, Walking

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