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Remote Utilization Review Nurse Jobs in Decatur, GA

Monogram Health

Market Physician Executive

Atlanta, GA · Remote

Review and approve APP, RN, SW, and PharmD plans of care. * Provide direct and indirect patient ... This position will be remote within the designated market with occasional in-home patient treatment ...

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Remote Utilization Review Nurse information

See Decatur, GA salary details

$20

$41

$67

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

As of Aug 22, 2026, the average hourly pay for remote utilization review nurse in Decatur, GA is $41.28, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.40 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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Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Decatur, GA as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $85,865 per year, or $41.3 per hour.

Remote Registered Nurse (Remote Patient Monitoring & Chronic Care Management)

3:15

Atlanta, GA • Remote

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Job TitleWe believe everyone should have confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the needs of our patients and connect on a personal level. We exist to coach people to their best health!ResponsibilitiesWelcome patients into continuous care program(s) and review benefits and services includedEducate patients on the frequency and use of their assigned in-home monitoring devicesCreate a personalized, comprehensive care plan with the patient via phone or video visitsIdentify and address any barriers to patient successProvide specific education and coaching on patients' chronic conditionsConnect with the patient frequently to review readings and a monthly update of their plan of careServe as the patient's first contact for all non-emergent needs (example - medication refills, scheduling, appointment reminders, etc.)Anticipate patients' needs and bridge any gaps in careAssist patients in the navigation of their healthcare (example - assisting patients with scheduling appointments, coordinating with specialists, and ensuring preventative screenings are completed, etc.).Review and evaluate in-home device readings in real time, during normal business hoursFollow established protocols for identifying, communicating and documenting device trends and any associated symptoms in the patient's medical recordEscalate concerning readings and/or symptoms to the provider following a communication protocol established by the providerEstablish a meaningful rapport that builds trust, open communication, and motivation to make a positive change in the patient's healthCollaborate with virtual team members and in-office staff to ensure patient's needs are being met

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