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Remote Utilization Review Rn Jobs in Delaware (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Dover, DE · On-site +1

$57.25 - $69.75/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Newark, DE · On-site +1

$56 - $68.25/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

BetterHelp

Licensed Psychologist-remote

Dover, DE · Remote

Work from the comfort of home (fully remote) * Flexible schedule - you set your own hours. * Free ... Also, we are unable to accept substance abuse counselors, school counselors, registered nurses ...

ZOLL Medical

Patient Service Representative

Dover, DE · Remote

$14 - $17.75/hr

Preferred Candidates include (not limited to): RN, EMT, Paramedic, EMS, Firefighter, PA, LPN, MA ... All candidates reviewed on an individual basis. Summary Description: The Cardiac Management ...

ZOLL Medical

Patient Service Representative

Wilmington, DE · Remote

$17 - $21.50/hr

Preferred Candidates include (not limited to): RN, EMT, Paramedic, EMS, Firefighter, PA, LPN, MA ... All candidates reviewed on an individual basis. Summary Description: The Cardiac Management ...

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

As of May 28, 2026, the average hourly pay for remote utilization review rn in Delaware is $42.32, according to ZipRecruiter salary data. Most workers in this role earn between $33.46 and $48.61 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review RN, and why are they important?

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

What is the difference between Remote Utilization Review Rn vs Remote Case Manager Rn?

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are popular job titles related to Remote Utilization Review Rn jobs in Delaware? For Remote Utilization Review Rn jobs in Delaware, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Delaware look for? The top searched job categories for Remote Utilization Review Rn jobs in Delaware are:
What cities in Delaware are hiring for Remote Utilization Review Rn jobs? Cities in Delaware with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Nurse, Virtual RN *$5000 Signing Bonus*

Nurse, Virtual RN *$5000 Signing Bonus*

Westside Family Healthcare, Inc.

New Castle, DE • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted yesterday

Job description

Job Type
Full-time
Description
WESTSIDE IS LOOKING FOR A NURSE / RN TO JOIN THE VIRTUAL NURSE TEAM!
SIGN ON BONUS OFFERED!
LOAN PAYOFF PROGRAMS AVAILABLE!
Join our dedicated healthcare team as a nurse, where each day presents a new opportunity to make a significant difference in the lives of our patients.
The Virtual RN is an experienced Registered Nurse (RN) working as part of a multidisciplinary team supporting general care processes, providers, and patients in an ambulatory community-based setting. The RN is responsible for evaluating and assessing patient's health care needs based on nurse assessment, clinical judgment, nurse process and evidence-based clinical support tools. The RN will provide appropriate disposition and timely follow up, per telephone triage policy. The RN must meet minimum quality and productivity standards as defined by Westside Family Healthcare.
Since opening our doors in 1988, Westside has been driven by our mission to improve the health of our communities by providing equal access to quality healthcare, regardless of ability to pay. With 240 team members, five health centers, one mobile health unit and over 27,000 patients all across Delaware, Westside is committed to improving health, one patient, one family, one community at a time.
Our Mission: To improve the health of our communities by providing equal access to quality healthcare, regardless of ability to pay
Our Vision: Achieve health access for all
Our Values:
  • Compassion: Lead with compassion
  • Service: Serve with humility
  • Excellence: Be exceptional
  • Empowerment: Empower all people

OUR BENEFITS: Our benefit package includes medical insurance, dental insurance, vision insurance, life and disability insurance, a 401(k) retirement plan with a match, and supplemental insurances. We offer a generous PTO package and flexibility to provide work/life balance. Westside Family Healthcare is an Equal Opportunity Employer that values diversity.
RESPONSIBILITIES of the Virtual RN Nurse role
1. Provide telephonic clinical assessment, health education and utilization management services across the life span,
2. Care coordination for patients, including prior authorization; identifying and seeking solutions for barriers to care
3. Provide telephonic triage for patients seeking care with multiple complaints
4. Assessment and provision of care using telecommunication devices
5. Application of the nursing process in telehealth care
6. Delivery of culturally sensitive, age-specific care to identified populations
7. Use of clinical decision support tools
8. Provide effective therapeutic communication, counsel and crisis management
9. Handle multiple in bound calls and ability to complete out-bound calls
10. Other duties as assigned.
Requirements
  1. Graduate of an accredited college or school of nursing with an Associates' degree in nursing
  2. Active, unencumbered Registered Nurse licensure in the State of Delaware or compact state
  3. Proficient with technology
  4. Two years of work experience in an ambulatory care, emergency services, med/surg, and/or pediatrics

Westside Family Healthcare is currently registered to employ remote workers in the following states: Arizona, Delaware, Maryland, North Carolina, Nebraska, New Jersey, Pennsylvania, Puerto Rico, Rhode Island, Texas, Virginia and West Virginia.

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