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Remote Utilization Review Nurse Jobs in Riverside, NJ

Ohm Systems, Inc

Be Seen First

Pharmacy Technician - Remote

Philadelphia, PA · Remote

$26.50 - $28.50/hr

Interprets and applies clinical criteria during the prior authorization review process and approves ... MEMBER CLAIMS HISTORY UTILIZATION * OUTBOUND CALLING * AUTHORIZATION SUBMISSION * Additional

Ohm Systems, Inc

Be Seen First

Prior Authorization Technician - Remote

Philadelphia, PA · Remote

$26.50 - $28.50/hr

Interprets and applies clinical criteria during the prior authorization review process and approves ... MEMBER CLAIMS HISTORY UTILIZATION * OUTBOUND CALLING * AUTHORIZATION SUBMISSION * Additional

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Remote Utilization Review Nurse information

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$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.

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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.

Pharmacy Technician - Remote

Ohm Systems, Inc

Philadelphia, PA • Remote

$26.50 - $28.50/hr

Contractor

This job post has expired 2 days ago. Applications are no longer accepted.

Job description

Shift
Position is remote. No time zone preference but shift times offered will be in EST time so candidates will need to adjust accordingly if in a different time zone.Shift Schedule: 8:30am-5:00pm EST, 9:00am-5:30pm EST, or 9:30am-6:00pm EST

Duties 

  • Reporting directly to the Supervisor, Prior Authorization Technicians, the Prior Authorization Technician I processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications.

Essential Functions

  • Interprets and applies clinical criteria during the prior authorization review process and approves requests if applicable
  • Utilizes member claims history during the prior authorization review process
  • Makes outbound calls to obtain additional information needed to process prior authorization requests
  • Submits authorizations to pharmacy and medical claims processors
  • Forwards prior authorization requests to a pharmacist when necessary
  • Makes appropriate referrals to other clinical programs
  • Assists in directing appropriate requests to in network providers
  • Receives inbound calls from the customer care center with prior authorization related inquiries
  • Assist with Appeals processing as assigned
  • Ability to multitask between various tasks and systems while maintaining required productivity and quality levels
  • Ability to make changes in a fast-paced environment
  • Strong knowledge of specialty and non-specialty pharmaceuticals
  • Performs other job-related duties and projects as assigned 
  • Attends required training on an annual basis.
  • Adheres to corporate and departmental policies and procedures.
  • Available to work weekends and holidays

Skills

  • 1 to 3 Years required.
  • Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.
  • Minimum 35 words per minute typing speed.
  • PRIOR AUTHORIZATION PROCESSING
  • CLINICAL CRITERIA INTERPRETATION
  • MEMBER CLAIMS HISTORY UTILIZATION
  • OUTBOUND CALLING
  • AUTHORIZATION SUBMISSION
  • Additional
  • REFERRAL MANAGEMENT
  • APPEALS PROCESSING
  • MULTITASKING
  • ADAPTABILITY
  • SPECIALTY PHARMACEUTICALS KNOWLEDGE
  • NON-SPECIALTY PHARMACEUTICALS KNOWLEDGE
  • PBM EXPERIENCE
  • MANAGED CARE EXPERIENCE
  • HOSPITAL PHARMACY EXPERIENCE
  • LTC PHARMACY EXPERIENCE
  • HOME INFUSION PHARMACY EXPERIENCE
  • RETAIL PHARMACY EXPERIENCE

Education

  • High School/GED Required
  • Certified Pharmacy Technician (PTCB or NHA). May be required to be licensed or certified in a specific state based upon contractual requirements and business need.
  • Requires working shift schedule outside standard business hours
  • Must remain in stationary position for long periods of time at desk or computer
  • Requires moving around office and non-office locations
  • Requires frequently moving about inside the office to access printer, files, and other materials/equipment
  • Operates a computer and other office equipment
  • Requires ability to Lift/Carry/Push/Pull - Typically less than 10 pounds

Company Description

Ohm Systems, Inc. specializes in IT and Healthcare staffing services, dedicated to linking highly skilled professionals with our public and private clients across the United States. Our track record showcases our commitment to delivering outstanding staffing and consultancy solutions to our clients. We prioritize diversity and inclusivity and take pride in being an employer that promotes equal opportunities and affirmative action. Our goal is to foster an inclusive work environment that embraces individuals from all backgrounds, irrespective of their gender, race, or orientation.