ZipRecruiter

Log In

2

Remote Utilization Review Nurse Jobs in Riverside, NJ

PONOS MGMT INC

New Jersey-RN Case Manager

Trenton, NJ · Remote

$45 - $60/hr

In this role, the nurse manages a complex caseload of members and provides both remote support and ... Participate in interdisciplinary team meetings and case reviews to align on care strategies and ...

PONOS MGMT INC

New Jersey-RN Case Manager

Camden, NJ · Remote

$45 - $60/hr

In this role, the nurse manages a complex caseload of members and provides both remote support and ... Participate in interdisciplinary team meetings and case reviews to align on care strategies and ...

PONOS MGMT INC

New Jersey-RN Case Manager

Burlington, NJ · Remote

$45 - $60/hr

In this role, the nurse manages a complex caseload of members and provides both remote support and ... Participate in interdisciplinary team meetings and case reviews to align on care strategies and ...

Monogram Health

Market Physician Executive

Trenton, NJ · Remote

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

previous pagenext page

Showing results 21-40

All JobsUtilization Review Nurse JobsRemote Utilization Review Nurse JobsRemote Utilization Review Nurse Jobs in Riverside, NJ

Remote Utilization Review Nurse information

See Riverside, NJ salary details

$21

$42

$69

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

As of Aug 19, 2026, the average hourly pay for remote utilization review nurse in Riverside, NJ is $42.70, according to ZipRecruiter salary data. Most workers in this role earn between $33.75 and $49.04 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.

More about Remote Utilization Review Nurse jobs

What job categories do people searching Remote Utilization Review Nurse jobs in Riverside, NJ look for?

The top searched job categories for Remote Utilization Review Nurse jobs in Riverside, NJ are:

What cities near Riverside, NJ are hiring for Remote Utilization Review Nurse jobs?

Cities near Riverside, NJ 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 Riverside, NJ as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 20% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $88,825 per year, or $42.7 per hour.

Clinical Consulting Pharmacist - Remote (must reside in PA or TN)

StateServ Medical LLC

Philadelphia, PA • Remote

$55.28 - $57.69/hr

Full-time

Re-posted 8 days ago

Job description

Schedule: Monday - Friday, 2:30PM - 11:00PMEST

Must reside in PA or TN to be considered.

Dragonfly Health - A great place to land

Dragonfly Health is the leading care-at-home data, technology and service platform, and the industry’s first scale durable medical equipment (DME) and pharmacy solution. Built on a 20-year history, Dragonfly Health uses advanced technology and robust analytics to manage DME and pharmaceutical services as part of a single, efficient solution for caregivers, patients, and their families. We serve over 145,000 patients every day in all 50 states.

Here, you are an integral part of a team that is transforming the future of hospice and post-acute healthcare. This is where innovation, collaboration and compassion thrive, allowing us to carry out our work at the highest level to serve our patients at a time in their life when they need us most.

We offer a dynamic and inclusive workplace where you'll have the unique opportunity to shape the future of healthcare alongside a passionate and talented team. We believe in empowering our employees to grow both personally and professionally, providing ample opportunities for career advancement, continuous learning, and skill development.

Dragonfly Health is our name for a reason.

The dragonfly is symbolic of the transformational impact we’re making on the industry, our people, and the lives we touch. We are a guiding force for what’s ahead, delivering more than equipment and medications, but also comfort and peace of mind. We are agile and adaptable, able to quickly and easily pivot from one point to the next, ready for whatever situation or patient need that arises.

Whatever it takes. Wherever it takes us. What we offer
  • Competitive Pay $55.28-57.69/hour + $5,000 sign-on bonus with shift differential (12% 6PM to 12:00AM and 15% 12:01AM-6AM)
  • Comprehensive Benefits Package (Health, Dental, Vision, PTO, Sick Time, 401k w/match, etc.)
  • Growth Opportunity and Career Advancement
  • Agile and Adaptable team culture
  • Innovative and revolutionary technology solutions
  • A higher calling to provide quality patient care

See how Dragonfly Health is transforming the world of hospice and post-acute care.

What you will do
  • Provide clinical review and consultation on medication requests, prior authorizations, and benefit determinations.
  • Evaluate therapy appropriateness, dosing, and safety based on evidence-based guidelines.
  • Collaborate with providers to clarify prescriptions and recommend alternatives when appropriate.
  • Support complex case reviews and appeals with accurate clinical documentation.
  • Identify opportunities to improve medication adherence, safety, and cost-effectiveness.
  • Educate internal teams on formulary management, utilization review, and pharmacy policy updates.
What we look for
  • R.Ph required; PharmD preferred
  • Full, current, and unrestricted pharmacist license in PA, TN, and/or OH
  • Ability to obtain additional state licensure based on business needs
  • 1+ year of pharmacy experience preferred (retail, hospital, or managed care)
  • Working knowledge of formulary management, clinical guidelines, and pharmacy benefit structures
  • Strong communication, analytical, and consultative skills
  • Ability to exercise sound clinical judgment and work independently
  • Commitment to evidence-based practice and continuous learning
Why Clinical Consulting Pharmacists are important

Every medication decision we make affects someone’s health, safety, and quality of life. As a Clinical Consulting Pharmacist, you ensure our members receive clinically appropriate, cost-effective therapies — helping balance patient care with responsible resource management. Your expertise directly advances our mission of improving health outcomes through compassionate, evidence-based pharmacy care.

Let's soar together