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Remote Utilization Review Nurse Jobs (NOW HIRING)

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Pacer Group

Medical Review RN IV

$50/hr

Remote - Candidate Must Reside in California Duration: 6+ Months Contract-to-Hire Schedule: Monday ... Working closely with Medical Directors, Utilization Management teams, Quality, Pharmacy, Claims ...

Northern Illinois Medical Center

Responsible for utilization review calls within BHS, including precertification, continued stay ... BSN with RN License. CERT BLS, CERT CADC, CERT CSADC, LIC CPC, LIC LCSW, LIC MSW, LIC RN. Equal ...

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Remote Utilization Review Nurse information

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$42

$68

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

As of Jul 2, 2026, the average hourly pay for remote utilization review nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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 cities are hiring for Remote Utilization Review Nurse jobs? Cities with the most Remote Utilization Review Nurse job openings:
What are the most commonly searched types of Utilization Review Nurse jobs? The most popular types of Utilization Review Nurse jobs are:
What states have the most Remote Utilization Review Nurse jobs? States with the most job openings for Remote Utilization Review Nurse jobs include:
What job categories do people searching Remote Utilization Review Nurse jobs look for? The top searched job categories for Remote Utilization Review Nurse jobs are:
Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in the United States as of June 2026, with employment types broken down into 88% Full Time, 7% Part Time, and 5% Contract. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
RN Utilization Management Reviewer

RN Utilization Management Reviewer

Sagility LLC

Remote

$35 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Sagility rating

4.6

Company rating: 4.6 out of 10

Based on 29 frontline employees who took The Breakroom Quiz

64th of 72 rated call and contact centers

Job description

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
Job title:
RN Utilization Management Reviewer
Job Description:
We are currently hiring a talented RN, Utilization Management Reviewer. This role will be responsible in day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS compliance standards in the area of service decisions and organizational determinations. Successful candidates must hold a valid, current license issued by the Massachusetts Board of Registration in Nursing.
Key responsibilities:
  • Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but not limited to surgical procedures, Medicare Part B medications, Long Term Services and Supports (LTSS), and Home Health (HH)
  • Applies established criteria (e.g., InterQual and other available guidelines) and employs clinical expertise to interpret clinical criteria to determine medical necessity of services
  • Communicates results of reviews verbally, in the medical record, and through official written notification to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements
  • Provides decision-making guidance to clinical teams on service planning as needed
  • Works closely with Clinicians, Medical Staff and Peer Reviewers to facilitate escalated reviews in accordance with Standard Operating Procedures
  • Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy
  • Works with UM Manager and other clinical leadership to ensure that departmental and organizational policies and procedures as well as regulatory and contractual requirements are met
  • Additional duties as requested by supervisor
  • Maintains knowledge of CMS, State and NCQA regulatory requirements

Education Requirements:
  • RN - Associate's Degree required, Bachelor's Degree preferred
  • RN, current license issued by the Massachusetts Board of Registration in Nursing
  • CCM (Certified Case Manager) a plus

Required Experience (must have):
  • 1 to 2 years Utilization Management experience.
  • 2 or more years working in a clinical setting

Desired Experience (nice to have):
  • 2 or more years of Home Health Care experience
  • 2 or more years working in a Medicare Advantage health Plan

Required Knowledge, Skills & Abilities (must have):
  • Ability to complete assigned work in a timely and accurate manner
  • Knowledge of the Utilization management process
  • Ability to work independently

Desired Knowledge, Skills, Abilities & Language (nice to have):
  • Ability to apply predetermined criteria (e.g., Medical Necessity Guidelines, InterQual) to service decision requests to assess medical necessity
  • Flexibility and understanding of individualized care plans
  • Ability to influence decision making
  • Strong collaboration and negotiation skills
  • Strong interpersonal, verbal, and written communication skills
  • Comfort working in a team-based environment
  • Knowledge of Medicare and Mass health services and benefits

Salary: $35.00 - $40.00 Hourly pending experience.
Hours: Monday through Friday 9AM to 5:30PM Eastern Time. May require weekends
This is a fully remote work at home role. You must have a secure, private wok at home area with a hardwired internet connection with speeds greater than 5MB upload and 10MB download.
Sagility Offers Competitive Benefits Including:
  • Medical
  • Dental
  • Vision
  • Life Insurance
  • Short-Term and Long-Term Disability
  • Flexible Spending Account
  • Life Assistance Program
  • 401K with employer contribution
  • PTO and Sick Time
  • Tuition Reimbursement

Join our team, we look forward to talking with you!
An Equal Opportunity Employer/Vet/Disability
Location:
Work@Home USAUnited States of America

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