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Remote Utilization Review Rn Jobs in Boston, MA (NOW HIRING)

Sedgwick

RN Field Case Manager

Boston, MA · Remote

$84K - $107K/yr

Must be an RN and prefers 1.5 years of prior workers compensation experience. PRIMARY PURPOSE OF ... remote work environment that allows face to face interaction with injured workers and medical ...

York Risk Services

RN Field Case Manager

Boston, MA · Remote

$84K - $107K/yr

Must be an RN and prefers 1.5 years of prior workers compensation experience. PRIMARY PURPOSE OF ... remote work environment that allows face to face interaction with injured workers and medical ...

VITRA Health

Nurse Compliance Manager

Boston, MA · Remote

$140K - $150K/yr

... audit reviews to strengthen regulatory adherence, audit readiness, and quality performance. You ... This role requires a strong clinical background (RN required), deep knowledge of healthcare ...

BMC HealthNet Plan

Medical Director

Boston, MA · On-site +1

$173K - $250K/yr

... reviews, evaluation of medical policy, utilization trend management, quality, appeals and ... Our Investment in You: • Full-time remote work • Competitive salaries • Excellent benefits ...

WellSense Health Plan

Medical Director

MA · On-site +1

$173K - $250K/yr

... reviews, evaluation of medical policy, utilization trend management, quality, appeals and ... Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key ...

DataAnnotation

Registered Nurse - AI Trainer

Boston, MA · Remote

$50 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

DataAnnotation

Registered Nurse - AI Trainer

Lowell, MA · Remote

$50 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Boston, MA

Remote Utilization Review Rn information

See Boston, MA salary details

$23

$45

$74

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 Boston, MA is $45.94, according to ZipRecruiter salary data. Most workers in this role earn between $36.30 and $52.74 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 Boston, MA? For Remote Utilization Review Rn jobs in Boston, MA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Boston, MA look for? The top searched job categories for Remote Utilization Review Rn jobs in Boston, MA are:
What cities near Boston, MA are hiring for Remote Utilization Review Rn jobs? Cities near Boston, MA 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 Boston, MA as of July 2026, with employment types broken down into 85% Full Time, 12% Part Time, and 3% Contract. Highlights an 40% Physical, 3% Hybrid, and 57% Remote job distribution, with an average salary of $95,545 per year, or $45.9 per hour.
Senior AI & Utilization Management Product Manager

Senior AI & Utilization Management Product Manager

Newfire Global Partners

Boston, MA • On-site, Remote

$150K - $181K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Job description

Senior AI & Utilization Management Product Manager
Department: Product Management
Employment Type: Full Time
Location: US
Compensation: $150,000 - $181,000 / year
Description
Job Title: Senior AI & Utilization Management Product Manager
Track: Individual Contributor (IC)
Experience: 7 - 10 years
Department: Product Management
Location: Care Lumen | Remote (US Only)
Reports to: Manager or Senior Manager, Product Management
Salary Range: $150000 - $181000
Bonus (if applicable): 10%
Scope
We're seeking an experienced Senior Product Manager to drive innovation in our Utilization Management (UM) platform, with a specific focus on leveraging AI technology to transform how clinicians perform medical necessity reviews. You'll own the product strategy and roadmap for our member clinical documentation system, working to dramatically reduce administrative burden while maintaining clinical quality and compliance. This role translates complex healthcare needs into scalable, secure, and compliant solutions that support real-world care and operations. The role is expected to operate with high autonomy, manage complex problem spaces, and apply strong product judgment to navigate ambiguity and trade-offs.
Serving as a strategic owner and connector, the Senior Product Manager drives clarity and alignment across teams and partners with leadership to ensure product priorities support organizational goals. This is an individual contributor role with significant cross-functional influence.
Key Responsibilities
  • Define and evolve product roadmaps, requirements, and success metrics grounded in user insights, healthcare domain understanding, and data
  • Lead discovery and delivery efforts that translate validated user needs into meaningful clinical, operational, and customer outcomes
  • Drive the integration of AI/ML capabilities to automate clinical documentation extraction, summarization, and decision support
  • Collaborate with data science and engineering teams to develop and refine AI models that assist with medical necessity determinations
  • Design intelligent workflows that surface relevant clinical information and reduce manual chart review time
  • Evaluate emerging AI technologies and vendors to inform build-vs-buy decisions
  • Own product direction and the end-to-end lifecycle for a major product line or module from discovery through delivery and outcome measurement
  • Drive cross-functional alignment by clarifying goals, framing trade-offs, and grounding decisions in data across engineering, design, and partner teams
  • Measure and optimize product performance by defining KPIs, monitoring results, and iterating based on insights and feedback
  • Partner closely with Customer Support, Implementation teams, and Clinical SMEs to support adoption, usability, and customer outcomes
  • Identify and advance opportunities for improvement and innovation informed by customer needs, market trends, and evolving healthcare models
  • Model strong product practices and elevate execution quality through influence, feedback, and shared standards.

Skills, Knowledge & Expertise
  • 7-10 years of product management experience, including ownership of complex product areas in health tech, healthcare IT, or similarly regulated domains
  • Demonstrated ability to own and deliver products end-to-end in complex, regulated environments, from discovery through launch and iteration
  • Strong understanding of healthcare ecosystems, including clinical workflows, customer segments, and regulatory context
  • Proven experience applying hypothesis-driven discovery and outcome-oriented development to drive meaningful product decisions
  • Deep familiarity with healthcare security, privacy, and compliance standards, and experience embedding these considerations throughout the product lifecycle
  • Strong product judgment and analytical skills, with the ability to translate domain complexity into clear priorities, trade-offs, and measurable outcomes
  • Excellent communication and stakeholder leadership skills, with a track record of influencing cross-functional teams without direct authority
  • Experience working closely with cross-functional teams including Engineering, Design, Data, and customer-facing partners in fast-paced environments
  • Experience building SaaS products in healthcare, with exposure to analytics, AI-enabled features, or population health solutions preferred

Preferred
  • Familiarity with regulatory requirements (NCQA UM standards, state regulations, CMS guidelines)
  • Experience with HIPAA-compliant AI implementations and healthcare data governance

Compensation & Benefits
Compensation & Benefits
The expected total cash compensation for this role is market-driven, with an expected starting salary of $150,000 - $181,000. Salary is ultimately determined based on a candidate's skills, expertise, and experience.
Care Lumen offers a robust and comprehensive benefits package including:
  • Remote-first environment with company provided computer
  • Thirteen paid holidays per year (average)
  • Medical, dental and vision coverage with multiple levels of coverage
  • HSA, FSA and Dependent Care accounts
  • Short-term and Long-term disability
  • Life and accidental death insurance
  • Discounted voluntary benefits, such as additional life insurance
  • Employee Assistance Program
  • Paid Parental Leave
  • Flexible vacation time
  • 401(k) with employer matching and immediate vesting

Offers are contingent upon successful completion of a background screening. Background screenings will be conducted in compliance with applicable laws and will not be initiated without your consent.
Care Lumen is an equal opportunity employer committed to building a diverse and inclusive workplace. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other legally protected status.
We are committed to providing reasonable accommodations to qualified individuals with disabilities in our job application process. If you need assistance or an accommodation due to a disability, please contact us at apply@carelumen.com.
About Care Lumen
Care Lumen is transforming healthcare by connecting people, care, and data-so that every decision leads to better outcomes. We empower care teams with a unified platform that delivers intelligent, real-time insights, streamlined workflows, and stronger collaboration across clinical, operational, and administrative domains.
Our vision is bold: to reimagine how care is delivered by unifying clinical operations and unlocking insights that improve lives. We believe in the power of great people and purposeful technology-and with all of us aligned around a common goal, our potential grows even stronger. We're building for impact today and evolving through innovation tomorrow.
We're a remote-first company that values flexibility, autonomy, and results over hours logged. We're guided by values that push us to excel, stay curious, and take smart risks. The best solutions come from teams that listen, learn, and build together. And we're focused on outcomes that matter-not just for our clients, but for the people they serve.
Care Lumen's LinkedIn
Care Lumen's website
Process - What to Expect
Our hiring process typically includes:
  1. Applied
  2. Recruiter Interview
  3. Hiring Manager Interview
  4. Second Hiring Manager Interview
  5. Panel Interview
  6. Second Panel Interview
  7. Offer
  8. Background Check
  9. Hired - Welcome to Care Lumen!

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