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Remote Utilization Review Rn Jobs in Appleton, WI

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Remote Utilization Review Rn information

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$41

$67

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

As of Jun 11, 2026, the average hourly pay for remote utilization review rn in Appleton, WI is $41.26, according to ZipRecruiter salary data. Most workers in this role earn between $32.60 and $47.36 per hour, depending on experience, location, and employer.

What is the meaning of the word remote?

In the context of a Remote Utilization Review RN job, 'remote' refers to working outside of a traditional office setting, often from home or another location of the employee's choice. This setup typically involves using digital tools and communication platforms to perform job duties without being physically present in an office environment.

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 meaning of remote in one word?

In the context of a Remote Utilization Review RN role, 'remote' means working from a location outside of a traditional office, typically from home, using digital communication tools. It emphasizes flexibility and virtual access to work systems without physical presence at a healthcare facility.

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.

How to make 2000 a week working from home?

A Remote Utilization Review RN can potentially earn $2,000 weekly by working full-time hours, often 40 hours per week, and gaining experience or certifications that allow for higher billing rates. Increasing income may involve taking on additional cases, specializing in high-demand areas, or working for agencies that offer competitive pay for remote utilization review roles.

What is remote job?

A remote Utilization Review RN job is a healthcare position where the nurse reviews patient cases and insurance claims from a location outside of a traditional office, often working from home. It requires strong communication skills, knowledge of medical documentation, and familiarity with electronic health record systems, with flexible schedules common in remote roles.

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 Appleton, WI? For Remote Utilization Review Rn jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Appleton, WI look for? The top searched job categories for Remote Utilization Review Rn jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Remote Utilization Review Rn jobs? Cities near Appleton, WI with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Nurse Practitioner (Per Diem)

Nurse Practitioner (Per Diem)

ComplexCare Solutions

Appleton, WI • On-site, Remote

$2K - $10K/mo

Other

Retirement

Posted 2 days ago

Job description

Overview
Nurse Practitioner Per Diem
This position covers all zip codes in: Outagamie County, WI
ComplexCare Solutions (CCS) specializes in helping those in need by delivering high-value home and virtual assessments for health plans nationwide. We pride ourselves on our member engagement aimed towards evaluating current health status, gaps in care, potential health risks and care management opportunities with a focus on driving better clinical outcomes.
CCS, on behalf of SME Medical Delaware, P.A., is calling on Advanced Practice Providers that are passionate about helping their local communities. We care dearly about those whom we serve, and we need your help to make a difference in the lives of our members. Providers have the opportunity to spend a full hour with these members, which allows them to capture a comprehensive picture of that individual's personal needs and what is required to keep them in the home and out of the hospital.
Compensation:
  • Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income
  • In-home visit rate: $120 - $140 depending on state of residence
  • If available, our telehealth rate is $85 per completed assessment

Benefit:
This position is eligible to participate in a company 401K plan providing the opportunity to save for retirement through employee contributions. New hires will be automatically enrolled in the company 401(k) plan at a 3% contribution rate with the option to opt out.
Responsibilities
  • Knowledge of CMS Regulations and NCQA HEDIS Guidelines
  • Knowledge of Evidence-based Clinical Practice Standards: American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA), Familiarity with ICD-10 and CPT-4 coding practices
  • Complete comprehensive, accurate and thorough review of the assigned member population, including timely completion and submission of all required encounter documentation (paper or electronic)
  • Ensure that all pertinent and active medical conditions are documented in the medical record in a manner compliant with CMS/DHHS, Company policy, and client requirements
  • Support the physician/patient relationship and ensure timely and adequate communication, documentation of assessment findings, recommendations, need for additional services, emergency services required if necessary and need for follow up and timelines for follow up to primary care provider (PCP) and health plan as required
  • Make general recommendations to members intended to improve members' knowledge of their chronic condition(s), such as information concerning recommended testing
  • Address and close identified gaps in care (disease-specific or preventive)
  • Recognize emergent or urgent situations requiring escalation and take appropriate action as specified in company policies, and as determined by reasonable professional judgment and ethical professional practice standards; and
  • Perform, document and communicate results of Point of Care (POC) Testing
  • Maintain compliance with Company policies, procedures and mission statement
  • Adhere to all confidentiality and HIPAA requirements as outlined within the Company's Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position
  • Fulfill those responsibilities and/or duties that may be reasonably provided for the purpose of achieving operational and financial success of the Company
  • Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function
  • On a monthly basis, be available for a minimum of 25 slots of availability per month (approximately 37 hours)
  • We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such
  • Other duties as assigned

Qualifications
  • Active un-encumbered license to practice nursing
  • ANCC or AANP board certification as a Nurse Practitioner or Clinical Nurse Specialist in Family, Adult, Gerontology or Emergency Medicine.
  • Maintains current CPR certification
  • Compliance, prior to hire, with recommended Healthcare Personnel Requirements for vaccinations and preventive testing:
    • Hepatitis B
    • Influenza
    • MMR: Measles, Mumps and Rubella
    • Pertussis, Tetanus and diphtheria and acellular pertussis (Tdap)
    • Varicella
    • Tuberculosis
  • Home Health exp a plus
  • Must be able to effectively communicate with elderly and chronically ill patients and families
  • Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial
  • Ability to multitask
  • Excellent customer service skills
  • Bi-lingual or multi-lingual a plus
  • Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision
  • Proficient with computer platforms, electronic health records (EHRs), secure messaging systems, and cloud-based documentation tools

This company utilizes E-Verify.
ComplexCare Solutions (CCS) is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. By embracing diversity, equity and inclusion we enhance our work environment and drive business success. ComplexCare Solutions (CCS) strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

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