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Remote Utilization Review Nurse Jobs in Rochester, NY

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · Remote

$60 - $65/hr

While this is a remote position, candidates must reside in or be willing to relocate to one of the ... Engage in the Utilization Review process for assigned cases every month * Respond to clinical ...

Lancesoft INC

Nurse Practitioner

Rochester, NY · Remote

$40 - $44.44/hr

Nurse Practitioner - Remote Research Study Reviewer Position: Remote - Part Time Work Hours: * Anticipate up to 10 participants per week * Each participant review is anticipated to require ...

IDEX

Assistant Controller

West Henrietta, NY · On-site +1

... reviews Reports key performance indices (KPI) for Operations, analyzes variances and provides ... This position is a remote role; however, we are seeking candidates who reside within reasonable ...

Valera Health

Mental Health Therapist

Rochester, NY · On-site +1

Collaborate within our vetted in-house network of health coaches, therapists, nurse practitioners ... Telehealth or remote experience * Self-motivated with strong independent work skills and ...

All JobsUtilization Review Nurse JobsRemote Utilization Review Nurse JobsRemote Utilization Review Nurse Jobs in Rochester, NY

Remote Utilization Review Nurse information

See Rochester, NY salary details

$21

$41

$68

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

As of Aug 1, 2026, the average hourly pay for remote utilization review nurse in Rochester, NY is $41.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 per hour, depending on experience, location, and employer.

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 to make $300,000 as a nurse online?

A remote utilization review nurse can potentially earn $300,000 annually by gaining specialized certifications, gaining extensive experience, and working for high-paying healthcare organizations or as a contractor. Building a strong reputation and handling complex cases can also increase earning potential, often through overtime or consulting opportunities. However, reaching this income level typically requires advanced skills, a flexible schedule, and continuous professional development.

How do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing or case management. Many employers prefer candidates with knowledge of healthcare policies, insurance processes, and utilization review procedures, and some roles may require certification such as the Certified Professional in Healthcare Quality (CPHQ).

What does a remote utilization review nurse do?

A remote utilization review nurse evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They work remotely, often using electronic health records and communication tools, to ensure that patient care aligns with insurance or healthcare guidelines. Certification in case management or utilization review is typically required for this role.

How to become a remote nurse reviewer?

To become a remote utilization review nurse, candidates typically need a registered nurse (RN) license, relevant clinical experience, and knowledge of insurance or healthcare policies. Additional certifications such as Certified Case Manager (CCM) or Utilization Review Certification (URAC) can enhance prospects, and strong communication skills are essential for reviewing medical records and making determinations remotely.

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.

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.

More about Remote Utilization Review Nurse jobs
What are the most commonly searched types of Utilization Review Nurse jobs in Rochester, NY? The most popular types of Utilization Review Nurse jobs in Rochester, NY are:
What are popular job titles related to Remote Utilization Review Nurse jobs in Rochester, NY? For Remote Utilization Review Nurse jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Nurse jobs in Rochester, NY look for? The top searched job categories for Remote Utilization Review Nurse jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Remote Utilization Review Nurse jobs? Cities near Rochester, NY 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 Rochester, NY as of July 2026, with employment types broken down into 3% As Needed, 59% Full Time, 16% Part Time, and 22% Contract. Highlights an 98% Physical, and 2% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.

LCSW Clinical Supervisor - Remote

Athena

Rochester, NY • Remote

$60 - $65/hr

Part-time

Re-posted 18 days ago

Job description

While this is a remote position, candidates must reside in or be willing to relocate to one of the following states prior to their start date:

Colorado, Connecticut, District of Columbia (Washington, D.C.), Florida, Massachusetts, Maryland, North Carolina, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Washington

Athena Mental Health is a New York State mental health-approved provider of community mental health services for children, adults, and families with behavioral and emotional challenges.  We specialize in individual and group psychotherapy for clients with a focus on trauma-informed care. We are dedicated to improving the quality and accessibility of mental health care for all, especially individuals from underserved communities.
 
Here at Athena, we pride ourselves on hiring a diverse group of mental health clinicians and staff who are passionate and dedicated to improving our clients’ overall emotional well-being. We provide both in-person and telehealth services for our clients and offer a competitive fee-for-service compensation plan and amazing benefits to our staff. 
 
Are You a Good Fit For Us?
We are currently seeking professional and compassionate Clinical Supervisors to join our growing team. Flexible hours are provided with the need of one weekend day and some evenings. In-person and telehealth sessions are conducted by our clinicians.
Responsibilities
  • Provide weekly clinical supervision to therapists as assigned, and document supervision sessions in a timely manner
  • Complete and maintain NYS licensure paperwork for supervisees as applicable
  • Assist with the development and facilitation of clinical training for staff in partnership with the leadership team
  • Work with the Clinical Director to cover administrative tasks as needed, including performance management of assigned therapists when necessary
  • Perform ongoing review of high-risk cases and provide clinical solutions as appropriate
  • Engage in the Utilization Review process for assigned cases every month
  • Respond to clinical crises and other clinical issues brought forward by supervisees
  • Help develop and improve clinical policies and procedures on an ongoing basis to support overall success of the program
  • Maintain a reduced caseload of therapy clients; complete all required clinical documentation promptly, including comprehensive assessments, treatment plans, and progress notes
Qualifications
  • NYS Independently Licensed Mental Health Provider (PhD, LCSW, LCSW-R, etc.)
  • Leadership experience in a mental health clinic setting
  • Bilingual in English and Spanish is preferred, but not required 
  • Previous experience using computerized appointment scheduling systems and/or electronic Medical Record Systems
  • Knowledgeable in NYS OMH Outpatient Clinic regulations
  • Knowledgeable in HIPAA Regulations
This is a fee-for-service role where you are compensated at a base rate per supervisory session.
Working Conditions
This position will be located at either the Manhattan office at 33 West 60th Street, New York, NY 10023, Suite 600, the Bronx office at 2825 Third Avenue, Suite 402, Bronx, NY 10455, 1299 Portland Ave, Suite 1, Rochester, NY 14621, or remotely. This is a professional work environment where a computer, desk, chair, and office supplies will be essential.
 
Physical Requirements
The physical demands described here are representative of those that must be met by an employee in order to successfully perform the essential functions of the role above. While performing the duties of this job, the employee is regularly required to hear and speak on the phone or through virtual telehealth sessions conducted on a computer throughout the day, stand and sit for an extended period of time and be able to write and answer emails in addition to carrying objects no greater than 25 pounds, when needed.
 
Direct Reports
This position has direct reports.
 
Athena is an Equal Opportunity Employer.
 
Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions. 

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.