ZipRecruiter

Log In

2

Remote Utilization Review Rn Jobs in Pennsylvania

The CKHobbie Group

$42 - $47/hr

This is a remote position. We are seeking a passionate and experienced HSS Clinical Coordinator RN to join our remote care coordination team. This is a high-impact, contract-to-hire opportunity ...

Corvel

Telephonic Case Manager I

Norristown, PA · Remote

$63K - $95K/yr

Current RN Licensure in state of operation * 3 or more years of recent clinical experience ... Strong cost containment background, such as utilization review or managed care helpful

Dane Street, LLC

... Record Reviews. This is a fully remote opportunity offering flexible scheduling, allowing you to ... Enhanced industry expertise in medical necessity, utilization review, and claims support * Expanded ...

Dane Street

Radiology - Imaging Physician

Philadelphia, PA · Remote

$322K - $403K/yr

... Record Reviews. This is a fully remote opportunity offering flexible scheduling, allowing you to ... Enhanced industry expertise in medical necessity, utilization review, and claims support * Expanded ...

Corry Manor

RNAC (PT) | Remote | Must be LOCAL

Corry, PA · Remote

$29.75 - $38/hr

Benefits for a MDS RN: * Promotion opportunities * Flexibility * Education/Learning * Competitive ... Must precheck and electronically submit MDS's to State agency, review validation reports and make ...

next page

Showing results 1-20

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

Remote Utilization Review Rn information

See Pennsylvania salary details

$21

$42

$69

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

As of Jul 23, 2026, the average hourly pay for remote utilization review rn in Pennsylvania is $42.38, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $48.65 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 Pennsylvania? For Remote Utilization Review Rn jobs in Pennsylvania, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Pennsylvania look for? The top searched job categories for Remote Utilization Review Rn jobs in Pennsylvania are:
What cities in Pennsylvania are hiring for Remote Utilization Review Rn jobs? Cities in Pennsylvania 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 Pennsylvania as of July 2026, with employment types broken down into 72% Full Time, 11% Part Time, and 17% Contract. Highlights an 43% Physical, 3% Hybrid, and 54% Remote job distribution, with an average salary of $88,158 per year, or $42.4 per hour.
Remote Work- HSS Clinical Coordinator RN (Advocacy in High Risk Maternity)

Remote Work- HSS Clinical Coordinator RN (Advocacy in High Risk Maternity)

The CKHobbie Group

On-site, Remote

$42 - $47/hr

Full-time

Posted 8 hours ago

Job description


This is a remote position.
We are seeking a passionate and experienced HSS Clinical Coordinator RN to join our remote care coordination team. This is a high-impact, contract-to-hire opportunity supporting high-risk maternity Medicaid members. You will play a vital role in promoting better outcomes for expectant mothers and newborns, with visibility to key state stakeholders.
Hours: Monday - Friday8:00 AM - 4:30 PM40 hrs/week
Fully Remote - Resides in South Eastern PA (Bucks, Montgomery, Chester, Philadelphia, or Delaware County)
Key Responsibilities:
  • Serve as a high-risk case manager for Medicaid maternity members
  • Deliver care coordination, health education, and community resource support
  • Conduct member assessments and develop care plans
  • Report on member cases in team rounds with the Medical Director
  • Prepare documentation for state reporting and attend related meetings
  • Provide culturally competent education and resources (e.g., doula programs, family visiting)
  • Collaborate with a team of 2 RNs, 1 LPN, and 1 Community Health Worker

Ideal Candidate Profile:
  • Registered Nurse (RN) with an active, unrestricted PA license
  • Resides in the Resides in South Eastern PA (Bucks, Montgomery, Chester, Philadelphia, or Delaware County)
  • 3-5 years of nursing experience in:
    • High-risk maternity care: Labor & Delivery or Antepartum Hospital Setting

Obstetric or Maternal-Fetal Medicine outpatient clinic/office
  • Strong background in Medicaid and managed care/health plan environments (preferred)
  • Excellent verbal and written communication skills
  • Tech-savvy (Microsoft Word, Excel, etc.)
  • Comfortable engaging with members via phone or video

Apply