ZipRecruiter

Log In

2

Remote Utilization Review Nurse Jobs in Springfield, OH

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

Remote Utilization Review Nurse information

See Springfield, OH salary details

$19

$38

$62

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

As of Aug 28, 2026, the average hourly pay for remote utilization review nurse in Springfield, OH is $38.09, according to ZipRecruiter salary data. Most workers in this role earn between $30.10 and $43.75 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 are popular job titles related to Remote Utilization Review Nurse jobs in Springfield, OH?

For Remote Utilization Review Nurse jobs in Springfield, OH, the most frequently searched job titles are:

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

The top searched job categories for Remote Utilization Review Nurse jobs in Springfield, OH are:

What cities near Springfield, OH are hiring for Remote Utilization Review Nurse jobs?

Cities near Springfield, OH 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, OH as of August 2026, with employment types broken down into 90% Full Time, and 10% Contract. Highlights an 100% Remote job distribution, with an average salary of $79,217 per year, or $38.1 per hour.

Clinical Care Reviewer II - RN - IN MCD - IN or MSL Licensed

Dayton, OH • On-site, Remote

CareSource
Insurance Services • 1 - 5K employees

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

208th of 313 rated insurance

Good employer

Good schedule notice

Paid breaks

Learn more about CareSourceexternal

$62K - $100K/yr

Full-time

Posted 3 days ago

New

Job description

Job Summary:
Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring the delivery of healthcare services.
Essential Functions:
  • Complete prospective, concurrent and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment
  • Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care
  • Engage with medical director when additional clinical expertise if needed
  • Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards
  • Identify and refer quality issues to Quality Improvement
  • Identify and refer appropriate members for Care Management
  • Provide guidance to non-clinical staff
  • Provide guidance and support to LPN clinical staff as appropriate
  • Attend medical advisement and State Hearing meetings, as requested
  • Assist Team Leader with special projects or research, as requested
  • Perform any other job related duties as requested.

Education and Experience:
  • Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required
  • Three (3) years clinical experience required
  • Med/surgical, emergency acute clinical care or home health experience preferred
  • Utilization Management/Utilization Review experience preferred
  • Medicaid/Medicare/Commercial experience preferred
Competencies, Knowledge and Skills:
  • Proficient data entry skills and ability to navigate clinical platforms successfully
  • Working knowledge of Microsoft Outlook, Word, and Excel
  • Effective oral and written communication skills
  • Ability to work independently and within a team environment
  • Attention to detail
  • Proper grammar usage and phone etiquette
  • Time management and prioritization skills
  • Customer service oriented
  • Decision making/problem solving skills
  • Strong organizational skills
  • Change resiliency
Licensure and Certification:
  • Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required
  • MCG Certification or must be obtained within six (6) months of hire required
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Travel is not typically required

Compensation Range:
$62,700.00 - $100,400.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Hourly
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-JM1
Brand=CareSource

What CareSource employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply