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Remote Utilization Review Nurse Jobs in Baton Rouge, LA

Imh

RN Care Manager

New Roads, LA · Remote

$41.20 - $62.17/hr

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

Imh

RN Care Manager - Inpatient

New Roads, LA · Remote

$41.20 - $62.17/hr

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

Imh

RN Care Manager - PRN

New Roads, LA · Remote

$41.20 - $62.17/hr

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

A-Line Staffing Solutions

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REMOTE- Prior Authorization Pharmacist

Baton Rouge, LA · Remote

$53/hr

Review cases for prospective and concurrent utilization management. * Collaborate with pharmacy technicians, nurses, providers, and healthcare professionals to collect necessary clinical information.

Amedisys, Inc.

Wound Care Director

Baton Rouge, LA · Remote

Conducts remote chart and wound image reviews for high-risk patients with wounds and provides ... Board certified with the Wound Ostomy, Continence Nurses Society, The American Board of Wound ...

micro1 AI

Clinical Pharmacy Technicians

Baton Rouge, LA · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

micro1 AI

Pharmacovigilance Expert

Baton Rouge, LA · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

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Remote Utilization Review Nurse information

See Baton Rouge, LA salary details

$16

$33

$54

How much do remote utilization review nurse jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for remote utilization review nurse in Baton Rouge, LA is $33.17, according to ZipRecruiter salary data. Most workers in this role earn between $26.20 and $38.08 per hour, depending on experience, location, and employer.

What is a remote utilization review nurse?

A Remote Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments, typically from a remote location such as their home. They review patient medical records, apply clinical guidelines, and collaborate with providers and insurance companies to ensure patients receive appropriate care while managing healthcare costs. This role often involves making coverage determinations, conducting pre-authorizations, and participating in appeals processes. Remote Utilization Review Nurses play a critical role in improving patient outcomes and resource allocation within the healthcare system.

What does a remote utilization review nurse do?

As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.

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

To thrive as a Remote Utilization Review Nurse, you need a current RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, EHR systems, and certifications like CCM or URAC are highly valued. Strong analytical thinking, attention to detail, and effective communication skills enable success in evaluating clinical documentation and collaborating with providers remotely. These skills and qualifications are essential to ensure efficient, compliant care decisions that optimize patient outcomes and resource use.

How does a remote utilization review nurse collaborate with physicians and other healthcare team members while working remotely?

As a Remote Utilization Review Nurse, collaboration with physicians, case managers, and other healthcare professionals is primarily conducted through secure digital platforms such as email, video conferencing, and electronic health record systems. Effective communication is essential to discuss patient care plans, clarify medical necessity, and ensure compliance with utilization policies. Nurses in this role often participate in virtual meetings or case conferences to present findings and recommendations. Building strong working relationships remotely requires proactive communication, responsiveness, and familiarity with digital collaboration tools.

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

AspectRemote Utilization Review NurseRemote Case Manager
CertificationsRN license, possibly CCM or UR certificationsRN license, CCM or case management certifications
Work EnvironmentHealthcare facilities, insurance companies, telehealthInsurance companies, healthcare organizations, telehealth
Job FocusReview medical necessity, approve or deny servicesCoordinate patient care, arrange services, discharge planning

Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.

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The most popular types of Utilization Review Nurse jobs in Baton Rouge, LA are:

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For Remote Utilization Review Nurse jobs in Baton Rouge, LA, the most frequently searched job titles are:

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Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Baton Rouge, LA as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 10% Part Time, 2% Temporary, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $68,998 per year, or $33.2 per hour.

Care Coordinator RN remote work: Baton Rouge or New Orleans

eQHealth Solutions

Baton Rouge, LA • Remote

Full-time

Re-posted 11 days ago

Job description

  • Performs care coordination services for assigned recipients who are eligible for home health services (Home Health Visits, PPEC, Personal Care Services and/or Private Duty Nursing Services etc. based on contract requirements).
  • Uses discretion to approve/validate UR or forward to 2nd level reviewer. Provides first level utilization review for all inpatient and outpatient services requiring authorization: Prospective Review Urgent/ Non-urgent, Concurrent Review and Retrospective Review.
  • Completes prior authorizations as appropriate in a timely manner.
  • Conducts an initial survey to recommend appropriate (home health assessment) for the recipient, unless this has already been done during the current fiscal year
  • Conducts a home and/or PPEC visit as needed or if contract requirement
  • Schedules and convenes initial face-to-face meeting in the recipient’s home and/or PPEC comprised of the recipient (if able) and the parent or legal guardian.
  • Assesses, plans, implements, monitors and evaluates the options and services required to meet the recipient’s health care needs.
  • Documents recipient’s assessment findings, actions, and outcomes.
  • Documents all communication, interventions and follow up tasks in the Care Coordination System within one (1) business day of each intervention and/or encounter.
  • Identifies patient care issues and makes recommendations on patient care issues.
  • Collaborates with the parent or legal guardian and healthcare team to arrange for identified home care needs.
  • Responsible for maintaining regular monthly contact (telephonically or face-to-face) with the recipient and the recipient’s parent or legal guardian.for purpose of updating Plan of Care (POC), resolving issues and identifying additional issues
  • As part of the multidisciplinary team, regularly meets with the team and contributes to the development of a comprehensive plan of care based on the needs of the recipient and recipient’s parent or legal guardian.
  • Evaluates and modifies recipient’s the plan of care as needed.  Regularly communicates changes to the recipient’s parent or legal guardian, healthcare team, and other agencies involved in the recipient’s care.
  • Monitors assigned caseload eligibility status on a monthly basis, based on their status in MMIS.
  • Completes a Staffing Tool (Freedom of Choice) any time a parent or legal guardian expresses the desire to reconsider a recipient’s placement into a Skilled Nursing Facility
  • Follow guidelines for additional required calls and visits for Skilled Nursing Facility (SNF) transitions to community settings for six (6) months.
  • Functions as a resource to the community.
  • Manages daily workload associated with quality review process, including facilitation of case assignments and follows up to ensure that all cases requiring additional assistance or care coordination are completed within timelines required by contract.
  •  Prioritizes and addresses requests and assignments in a professional manner to develop cooperative relationships to ensure that customer confidentiality is assured.
  • Provides courteous and prompt service to all internal and external customers at all times.
  • Attends staff meetings and continuing education sessions and will assist with learning opportunities as needed.
  • Participates in special projects, as needed.
  • Assists with the implementation of quality improvement initiatives.
  • Performs other duties as assigned.

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