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Remote Utilization Review Rn Jobs in Maine (NOW HIRING)

University of Rochester

$81K - $105K/yr

Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management ... Registered Nurse License, current in NYS upon hire required or NP - Nurse Practitioner license ...

University of Rochester

$81K - $105K/yr

Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management ... Registered Nurse License, current in NYS upon hire required or NP - Nurse Practitioner license ...

University of Rochester

$81K - $105K/yr

Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management ... Registered Nurse License, current in NYS upon hire required or NP - Nurse Practitioner license ...

University of Rochester

$81K - $105K/yr

Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management ... Registered Nurse License, current in NYS upon hire required or NP - Nurse Practitioner license ...

University of Rochester

$81K - $105K/yr

Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management ... Registered Nurse License, current in NYS upon hire required or NP - Nurse Practitioner license ...

OneAmerica

Clinical Care Consultant

South Portland, ME · On-site +1

... reviews of medical information. This role is responsible for discussing and documenting an ... Current & active Registered Nurse (RN) license in their state of residency required. BSN preferred.

Guardian Recovery

THERAPIST

South Portland, ME · On-site +1

$55K - $86K/yr

Registered Nurse certified as a Psychiatric Nurse, b. Advanced Practice Registered Nurse (APRN) ... C. 10:161A-1.9 employment, with progress towards certification or licensing on file, reviewed by ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Maine

Remote Utilization Review Rn information

See Maine salary details

$20

$40

$66

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

As of Jul 11, 2026, the average hourly pay for remote utilization review rn in Maine is $40.94, according to ZipRecruiter salary data. Most workers in this role earn between $32.36 and $47.02 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 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 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 are popular job titles related to Remote Utilization Review Rn jobs in Maine? For Remote Utilization Review Rn jobs in Maine, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Maine look for? The top searched job categories for Remote Utilization Review Rn jobs in Maine are:
What cities in Maine are hiring for Remote Utilization Review Rn jobs? Cities in Maine with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Maine as of July 2026, with employment types broken down into 85% Full Time, 11% Part Time, and 4% Contract. Highlights an 40% Physical, 2% Hybrid, and 58% Remote job distribution, with an average salary of $85,150 per year, or $40.9 per hour.
Clinical Document Spec

Clinical Document Spec

University of Rochester

On-site, Remote

$81K - $105K/yr

Full-time

Posted 27 days ago

University Of Rochester rating

8.3

Company rating: 8.3 out of 10

Based on 181 frontline employees who took The Breakroom Quiz

103rd of 552 rated colleges and universities

Job description

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.
Job Location (Full Address):
601 Elmwood Ave, Rochester, New York, United States of America, 14642
Opening:
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
500009 Utilization Management
Work Shift:
UR - Day (United States of America)
Range:
UR URCE 215
Compensation Range:
$81,310.00 - $105,703.00
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Responsibilities:
Facilitates clinical documentation improvement through concurrent and retrospective interaction with physicians and members of the healthcare team. This interaction supports the clinical severity of the inpatient admission, quality documentation standards that align with federal and state regulations and assists with maximizing revenue.
Essential Functions:
  • Recognizes gaps and facilitates modifications in clinical documentation that support the accuracy of medical conditions for inpatient encounters. Recognizes documentation opportunities with the assistance of computer software. Conducts clinical documentation improvement efforts through query processes.
  • Provides oversight of EPARC, including UM and unbilled work queues. Communicates with individual physicians and medical team, providing guidance and clarification around principle diagnoses, complicating conditions, and diagnoses being treated to ensure complete and accurate documentation in the medical record.
  • Presents overall findings to key stakeholders, including leadership and peers. Provides education to peers and healthcare team members on documentation improvement, reimbursement opportunities, and overall performance.
  • Demonstrates knowledge of trends in clinical diagnoses that result in payer denials. Ensures the validity of data for reporting and measuring physician and hospital outcomes through software and data analysis. Audits clinical documentation to confirm points of clarification have been entered in the medical record.
  • Meets established productivity expectations of the CDI program. Maintains knowledge of hospital clinical practice guidelines to support the most thorough review of the medical record.
  • Other duties as assigned.

Minimum Education & Experience:
  • Bachelor's degree in Nursing (BSN) and 5 years of inpatient clinical experience, knowledge of complex disease processes required OR
  • Bachelor's, Master's or Doctorate degree in a relevant clinical discipline: Prepared Physician Assistant (PA) or Nurse Practitioner (NP) or Bachelor of Medicine, Bachelor of Surgery (MBBS) or Doctor of Medicine/Osteopathic Medicine (MD/DO) and 5 years inpatient clinical experience, knowledge of complex disease processes required.
  • Or equivalent combination of education and experience.
  • Prior experience with EPARC, eRecord, HDM, and SharePoint preferred.

Licenses and Certifications:
  • Registered Nurse License, current in NYS upon hire required or NP - Nurse Practitioner license, current in NYS upon hire required or PA - Physician Assistant license current in NYS upon hire required or MD - Doctor of Medicine - MD License current in NYS upon hire required or DO - Doctor of Osteopathic Medicine current DO License in NYS upon hire required AND Clinical Documentation Specialist (CDS) upon hire preferred or CDIP - Clinical Documentation Improvement Professional upon hire preferred

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University's Mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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