ZipRecruiter

Log In

2

Remote Utilization Review Rn Jobs in Ohio (NOW HIRING)

Humana

Quality Assurance Professional

Toledo, OH · Remote

Collect, review records, summarize issues and analyze data daily, weekly, monthly, or as needed to ... Licensed healthcare professional in the state of Michigan: LPN, RN, LMSW, LBSW. * Previous Medicare ...

Humana

Quality Assurance Professional

Toledo, OH · Remote

Collect, review records, summarize issues and analyze data daily, weekly, monthly, or as needed to ... Licensed healthcare professional in the state of Michigan: LPN, RN, LMSW, LBSW. * Previous Medicare ...

Gentell

Certified Wound Care Clinician/Nurse

Dayton, OH · On-site +1

... utilization of wound care products - Understanding Medicare documentation and reimbursement ... (RN, LPN, PT, OTR-L, DPM or similar) preferred but could be certified in the first year of hire ...

King's Daughters

APP I, School

South Point, OH · On-site +1

Actively participate in the maintenance of quality improvement initiatives, peer review processes ... Active and unrestricted as a Registered Nurse and Nurse Practitioner or Physician Assistant in the ...

SPECIALTY RX, Inc.

Remote Pharmacist

Columbus, OH · On-site +1

$58 - $60/hr

We are a long-term care pharmacy providing pharmaceutical services to skilled nursing facilities ... Review, verify, and approve high-volume medication orders for long-term care residents. * Perform ...

SpecialtyRx, Inc.

Remote Pharmacist

Columbus, OH · Remote

$56.25 - $67.50/hr

We are a long-term care pharmacy providing pharmaceutical services to skilled nursing facilities ... Review, verify, and approve high-volume medication orders for long-term care residents. * Perform ...

Little Acorn ABA

BCBA-remote

Cleveland, OH · Remote

$70K - $85K/yr

BCBA-remote Company: Little Acorn ABA Location: Ohio We're here to nurture the mighty oak that ... Registered Behavior Technicians implementing treatment programs. * Monitor client progress: Review ...

previous page

Showing results 41-60

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

Remote Utilization Review Rn information

See Ohio salary details

$20

$40

$65

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

As of Sep 14, 2026, the average hourly pay for remote utilization review rn in Ohio is $40.20, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.15 per hour, depending on experience, location, and employer.

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 are the key skills and qualifications needed to thrive as a remote utilization review RN?

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 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 the most commonly searched types of Utilization Review Rn jobs in Ohio?

The most popular types of Utilization Review Rn jobs in Ohio are:

What are popular job titles related to Remote Utilization Review Rn jobs in Ohio?

For Remote Utilization Review Rn jobs in Ohio, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in Ohio look for?

The top searched job categories for Remote Utilization Review Rn jobs in Ohio are:

What cities in Ohio are hiring for Remote Utilization Review Rn jobs?

Cities in Ohio 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 Ohio as of September 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 100% Remote job distribution, with an average salary of $83,610 per year, or $40.2 per hour.

Quality Assurance Professional

Toledo, OH • Remote

Humana
Health Care and Social Assistance • 10K+ employees
Learn more about Humanaexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

Humana rating

8.0

Company rating: 8.0 out of 10

Based on 267 frontline employees who took The Breakroom Quiz

Job description

Become a part of our caring community
The Quality Assurance Professional 2 reviews Long-Term Services and Support (LTSS) contractor documentation and performance to ensure compliance with contract scope of work, and state and federal regulations. You will ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse to ensure appropriate course of action. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Your work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
  • Comply, conduct, and summarize compliance audits/reports to include deficiencies and risks.
  • Collect, review records, summarize issues and analyze data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals.
  • Conduct inter-rater reliability audits for multiple vendor activities such as Home- and Community-Based Services (HCBS) service calculators and nursing facility level of care determination assessments to ensure accurate and consistent application of state and Humana guidelines.
  • Ensure Michigan Department of Health and Human Services (MDHHS), National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and Humana Gold-Plus Integrated Policy and Procedures are followed.
  • Ensure auditing is completed timely and communicated with leadership.
  • Make decisions regarding own work methods, occasionally in ambiguous situations, and require minimal direction and receives guidance where needed.
  • Other duties as assigned by the LTSS leadership team.

Use your skills to make an impact

Required Qualifications

  • Must reside in Michigan or within a 40-mile radius of the Michigan border in Ohio or Indiana.
  • Bachelor's degree.
  • Two (2) or more years of experience in care management, utilization management, quality assurance and/or population health supporting the Long-Term Services and Supports (LTSS) population.
  • Previous experience working with Managed Care Organization.
  • Proficiency in analyzing, tracking, and interpreting data trends to identify improvement opportunities and ensure adherence to operational guidelines, policies, and procedures.
  • Proficient with Microsoft Office products including Word Excel, Power Point, and Outlook.

Preferred Qualifications

  • Licensed healthcare professional in the state of Michigan: LPN, RN, LMSW, LBSW.
  • Previous Medicare/Medicaid, MDHHS, CMS, and NCQA experience.

Additional Information

  • Workstyle: This is a remote position.
  • Travel: Up to 10% travel, including occasional travel for audits, accreditation-related activities, and team engagement meetings at Humana's Detroit, Michigan location.
  • Typical Work Schedule: Monday through Friday; 8:00 AM to 5:00 PM Eastern Time (ET).
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$65,000 - $88,600 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

What Humana employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Humana logo

About Humana

Sourced by ZipRecruiter

Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Louisville, KY, US

Year founded

1961

Social media

FacebookTwitter

View All Humana Jobs

Apply