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Remote Utilization Review Rn Jobs in Everett, MA

Mass General Brigham

Senior Nurse Reviewer

Somerville, MA · On-site +1

$79K - $115K/yr

Registered Nurse [RN - MA State License] - required * 3+ years of experience in clinical nursing ... Remote, M-F eastern standard business hours. Requires a quiet, secure, HIPAA-compliant working ...

Massgeneralbrigham

Senior Nurse Reviewer

Somerville, MA · Remote

$79K - $115K/yr

Registered Nurse [RN - MA State License] - required * 3+ years of experience in clinical nursing ... Remote, M-F eastern standard business hours. Requires a quiet, secure, HIPAA-compliant working ...

UnitedHealth Group

Clinical Appeals RN

Boston, MA · Remote

$28.94 - $51.83/hr

... review of services. Works closely with managers and peers. If you currently reside in the state of ... Utilization Management experience * Appeals Experience * Medicare/Medicaid experience preferred

Varsity Tutors

NCLEX-RN Tutor

Lynn, MA · Remote

$40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Cambridge, MA · Remote

$40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Quincy, MA · Remote

$40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

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Remote Utilization Review Rn information

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

As of Jun 19, 2026, the average hourly pay for remote utilization review rn in Everett, MA is $43.53, according to ZipRecruiter salary data. Most workers in this role earn between $34.42 and $50.00 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 Everett, MA? For Remote Utilization Review Rn jobs in Everett, MA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Everett, MA look for? The top searched job categories for Remote Utilization Review Rn jobs in Everett, MA are:
What cities near Everett, MA are hiring for Remote Utilization Review Rn jobs? Cities near Everett, MA with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you

Clinical Quality Assurance Coordinator (RN) (32085)

IME RESOURCES LLC

Norwood, MA • Remote

$30 - $31.25/hr

Full-time

Posted 21 days ago

Job description

Calling All RN's! 

Are you an RN looking for an exciting new opportunity? MES is on the hunt for a talented Clinical Quality Assurance Coordinator to join our growing team! In this role, you’ll dive into medical records, pulling out key details and crafting detailed narrative summaries. Your keen eye for detail will make you an invaluable part of our quality assurance process.

Why You’ll Love This Role:

     -100% Remote – Work from where you're most comfortable - home!
     -Flexible Hours –Monday-Friday 8:00am-4:30pm early shift (3 days) 10:00am-6:30pm (1 day) and 12pm-8:30pm (1 day) ALL ET
      -Great Training – The first 4-6 weeks of training are designed to set you up for success, with a preferred training schedule of 12:00pm-                8:30pm EST.

At MES, we’re an employee-first company offering fantastic benefits and incredible growth opportunities. If you’re ready to take the next step in your career with a team that values your expertise, we want to hear from you!

Essential duties and responsibilities to perform this job successfully include, but are not limited to the following:

  • Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
  • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinationsEnsures that all client instructions and specifications have been followed and that all questions have been addressed.
  • Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
  • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
  • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
  • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
  • Ensures the provider credentials and signature are adhered to the final report.
  • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
  • Assists in resolution of customer complaints and quality assurance issues as needed.
  • Ensures all federal ERISA and/or state mandates are adhered to at all times.
  • Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
  • Promote effective and efficient utilization of company resources.
  • Participate in various educational and or training activities as required.

MINIMUM REQUIRED QUALIFICATIONS

Education and/or Experience  

High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience preferred. Knowledge of the insurance industry, preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, or disability preferred.

Certificates, Licenses, Registrations

LPN/LVN/RN may be required based on business needs.

ESSENTIAL COMPETENCIES

QUALIFICATIONS 

  • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
  • Must be a qualified typist with a minimum of 40 W.P.M
  • Must have a full understanding of HIPAA regulations and compliance.
  • Must be able to operate a general computer, fax, copier, scanner, and telephone.
  • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
  • Must demonstrate exceptional communication skills.
  • Ability to follow instructions and respond to upper managements’ directions accurately.
  • Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitors own work to ensure quality is met.
  • Must be able to work independently, prioritize work activities and use time efficiently.
  • Must be able to maintain confidentiality.
  • Must be able to demonstrate and promote a positive team -oriented environment.
  • Must be able to stay focused and concentrate under normal or heavy distractions.
  • Must be able to work well under pressure and or stressful conditions.
  • Must possess the ability to manage change, delays, or unexpected events appropriately.
  • Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.


MES is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

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