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Remote Utilization Review Nurse Jobs in Springfield, MA

Sentara

IT Specialty Analyst (Epic) - Remote

MA · Remote

This role partners closely with clinical leadership, providers, nursing, and operational ... for optimal utilization of applications. Develops system test plans and performs testing of ...

ReSource Pro

Director Client Development

Hartford, CT · On-site +1

$120K - $205K/yr

All remote positions are based in the United States, and candidates must reside within the U.S. to ... Conduct quarterly and annual performance reviews tied to sales outcomes, including win rates, deal ...

ReSource Pro

Director Client Development

Hartford, CT · Remote

$120K - $205K/yr

All remote positions are based in the United States, and candidates must reside within the U.S. to ... Conduct quarterly and annual performance reviews tied to sales outcomes, including win rates, deal ...

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All JobsUtilization Review Nurse JobsRemote Utilization Review Nurse JobsRemote Utilization Review Nurse Jobs in Springfield, MA

Remote Utilization Review Nurse information

See Springfield, MA salary details

$20

$41

$67

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 Springfield, MA is $41.15, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.26 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 Springfield, MA? The most popular types of Utilization Review Nurse jobs in Springfield, MA are:
What are popular job titles related to Remote Utilization Review Nurse jobs in Springfield, MA? For Remote Utilization Review Nurse jobs in Springfield, MA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Nurse jobs in Springfield, MA look for? The top searched job categories for Remote Utilization Review Nurse jobs in Springfield, MA are:
What cities near Springfield, MA are hiring for Remote Utilization Review Nurse jobs? Cities near Springfield, MA 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 Springfield, MA as of July 2026, with employment types broken down into 2% As Needed, 58% Full Time, 19% Part Time, 1% Temporary, and 20% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $87,639 per year, or $42.1 per hour.

Remote Registered Nurse (RN) Case Manager

Valeris

Hartford, CT • Remote

$50K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 29 days ago

Job description

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.
As a Nurse Advocate you are responsible for contact with program patients and assessing any barriers that may be present for successful initiation and completion of therapy. The Nurse Advocate will play an active role with each patient from the first point of patient program enrollment and throughout treatment to facilitate a timely and successful patient experience.
Key Responsibilities:
  • Serve as a consistent resource throughout the continuum of program services, which includes identifying barriers to therapy and helping the patient understand and navigate such barriers.
  • Serve as an educator who possesses knowledge and practical experience about clinical treatments and the strong emotions and financial implications associated with a new diagnosis, living with a chronic medical condition or life-threatening condition.
  • Enable patients by providing them with information and education about:
    • their prescribed therapy and course of treatment, fairly balanced with benefits and known side effects per manufacturer product information
    • proper administration and dosing of prescribed therapy
    • calling and working with the patient’s insurance payer to determine coverage benefits, anticipated out-of-pocket costs associated with their therapy and resources for financial assistance, where applicable based upon needs communicated by the patient
    • support to help better manage the stress involved in their diagnosis.
    • Empower the patient to participate in their personal care process by triaging the patient to support for other non-program needs such as social or other intervention programs.
  • Reporting of Adverse Events/ Product Complaint received in accordance with SOP and good manufacturer practices
  • Utilize Valeris’ values as the driving force behind the team’s success
  • On time adherence to training deadlines for all corporate policies and procedures
  • Ensure all SOPs are followed with consistency
  • Perform additional tasks or projects as assigned
Qualifications:
  • Must have active RN licensure in current state of practice.
  • 2-3 years of nursing experience with relevant disease state experience preferred.
  • Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus.
  • Case management or Clinical Trial Nurse experience, a plus.
  • Bachelor's degree preferred.
  • Remote work eligibility is subject to all work from home criteria met and based on business need.
Physical Demands amp; Work Environment
  • While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
  • Although very minimal, flexibility to travel as needed is preferred.
  • This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
Why Work for Valeris?
We’re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:
  • Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
  • Additional health support, including telehealth and Employee Assistance Program (EAP) services
  • Company match on Health Savings Account contributions
  • Free Basic Life and AD amp;D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
  • Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
  • 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
  • Paid Time Off (PTO) and Sick Leave to support work-life balance
  • Team members receive nine paid holidays plus two floating holidays
  • Opportunities for advancement in a company that supports personal and professional growth
  • A challenging, stimulating work environment that encourages new ideas
  • Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
  • A mission-driven, inclusive culture where your work makes a meaningful impact
Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.
Our Commitment to Equal Opportunity
At Valeris, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.
Important Notice

Due to an increase in hiring scams, please be aware that if you are selected to move forward in our hiring process, a member of our Talent Acquisition team will contact you directly using an official @pharmacord.com and/or @valeris.com, @echo.newtonsoftware.com email address regarding next steps in our interview process.

Please Note:
  • PharmaCord will never use Microsoft Teams to reach out to candidates for interview scheduling. However, video interviews are typically conducted via Microsoft Teams. Official meeting links will always be sent from an @valeris.com, @pharmacord.com or @echo.newtonsoftware.com email address, or through our scheduling platform, Calendly.
  • We will never request your bank account information at any stage of the hiring process.
  • We will never send a check (electronic or physical) to purchase home office equipment.

If you receive any suspicious communication regarding employment with PharmaCord, please report it to our Talent Acquisition team immediately at careers@pharmacord.com

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