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Remote Utilization Review Nurse Jobs in Decatur, GA

US Tech Solutions

Licensed Vocational Nurse

Atlanta, GA · Remote

$25 - $27/hr

$25-$27 per hour remote, GA Contract This is a remote position and requires the ability to ... Review criteria-based prior authorizations following policy and procedure. * Provide on-call after ...

Urrly

Telehealth Nurse Practitioner (Remote)

Atlanta, GA · Remote

$600 - $720/hr

Telehealth Nurse Practitioner * Location/Type: Georgia Remote (No travel) * Pay: $600$720/day (1099 ... Review medical history, medications, preventive needs * Document visits using ICD-10 and CPT II ...

CGI Inc.

Remote Clinical Nurse Auditor

Atlanta, GA · On-site +1

Methods for reviewing medical records and provider documentation. The application of appropriate screening guidelines. The use of documentation formats tailored to Client requirements. Ongoing ...

Integrated Resources INC

Case Manager

Alpharetta, GA · Remote

$19.50 - $25.25/hr

Master's This is a TEMP- TO-PERM Care Manager RN position. The position is created to meet and ... reviews utilization of mental health and substance abuse services provided in inpatient and ...

OncoHealth

Case Review Specialist - Atlanta

Atlanta, GA · On-site +1

Experience working remote independently * A minimum of 2-4 years' administrative experience and/or ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...

OncoHealth

Case Review Specialist - Atlanta

Atlanta, GA · On-site +1

Experience working remote independently * A minimum of 2-4 years' administrative experience and/or ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...

Urrly

Telehealth Nurse Practitioner

Atlanta, GA · Remote

$600 - $720/day

Location/Type: Georgia Remote (No travel) * Pay: $600-$720/day (1099 contractor, based on ... Review medical history, medications, preventive needs * Document visits using ICD-10 and CPT II ...

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

As of Jun 1, 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 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, and why are they important?

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 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 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.

More about Remote Utilization Review Nurse jobs
What are popular job titles related to Remote Utilization Review Nurse jobs in Decatur, GA? For Remote Utilization Review Nurse jobs in Decatur, GA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Nurse jobs in Decatur, GA look for? The top searched job categories for Remote Utilization Review Nurse jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Remote Utilization Review Nurse jobs? Cities near Decatur, GA with the most Remote Utilization Review Nurse job openings:
Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Decatur, GA as of May 2026, with employment types broken down into 1% As Needed, 86% Full Time, 2% Part Time, and 11% Contract. Highlights an 93% Physical, and 7% Remote job distribution, with an average salary of $85,865 per year, or $41.3 per hour.
Physician / Surgery - Orthopedics / Georgia / Permanent / Associate Medical Director - Orthopedic...

Physician / Surgery - Orthopedics / Georgia / Permanent / Associate Medical Director - Orthopedic...

eviCore healthcare

Atlanta, GA • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted yesterday

Job description

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.
Participates in strategic planning for and evaluation of the Care Management
The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Surgery - Orthopedics, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).
Must have a minimum of 5 years clinical experience, beyond residency/fellowship
Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required
No nights, no weekends, not call.
Predictable work schedule
Full and part time opportunities
Salaried position with benefits
Supportive organization with collaborative culture
eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to:
Flexible scheduling and work/life balance with remote and work from home opportunities
4 weeks of PTO(starting) per year plus paid holidays
One week of CME
Education assistance, tuition reimbursement and professional certifications
Health, dental, vision, and life benefits with employer funded HSA
Paid Volunteer Community Service Days
Ample opportunities for growth, advancement, and promotion
401k retirement plan with company match of 50% employee contributions up to 6%
eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation

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