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

As of Jul 6, 2026, the average hourly pay for remote utilization review rn in Miami, FL is $40.44, according to ZipRecruiter salary data. Most workers in this role earn between $31.97 and $46.44 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.
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Remote Utilization Review Rn jobs near you
Utilization Review Nurse (U)

Utilization Review Nurse (U)

The University of Miami

Miami, FL • On-site, Remote

Full-time

Medical, Dental

Posted 12 days ago

University Of Miami rating

7.7

Company rating: 7.7 out of 10

Based on 52 frontline employees who took The Breakroom Quiz

224th of 544 rated colleges and universities

Job description

Current Employees:
If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet.
The Case Manager RN (U) coordinates the overall interdisciplinary plan of care for patients, from admission to discharge. Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. Evaluates the needs of the patient, the resources available, and recommends and facilitates the plan for the best outcome. Develops a discharge plan that provides the best available resources to meet ongoing patient needs and that encourages compliance with medical advice. Identifies patient care issues and suggests revisions to or new clinical pathways to improve quality of care.Care facilitation for all assigned patients including extended recovery, outpatient observation and inpatient admissions to include care progression, timely consultations and testing facilitation , assure social service intervention and individual discharge planning that will include assuring that the transfer or discharge of a patient to another level of care, treatment, services or different setting is always based on the patient's assessed needs, patient's insurance coverage benefits and the organizations capabilities to meet these needs.
  • Incorporate the fundamental principles of monitoring resource consumption and capture of avoidable days.
  • Enter Ancillary notes utilizing the templates for care facilitation.
  • Proactive in assuring the orders needed are obtained and facilitates delivery of clinical and community services to patients and families through effective utilization of available resources.
  • Attend daily multidisciplinary huddles, meeting facilitation/address progression of care.
  • Ensures the appropriateness and cost effectiveness of patient's plan of care based on DRG.
  • Proactively collaborate with physicians(s) to develop patient care plans and review medical needs for continued hospital services and resource consumption.
  • Utilize Case Manager nurse driven protocols to facilitate care and request physician orders on items not part of CM nursing protocol.
  • Provide all required Medicare documents to the patient and/or proxy when applicable inclusive of the discharge Important Message from Medicare, Code 44 patient notification required documents.
  • Process QIO Medicare appeals.
  • Acute Care transfers including Psychiatric transfers.
  • Attend and facilitate the daily multi-disciplinary huddles.
  • Attend and report on assigned LOS 10day outliers-Complex Case Review.
  • Communicate to management daily on observation outliers related to care transition and discharge barriers.
  • Identifies the patients' risk factors or obstacles to care, and discharge and readmission risk.
  • Evaluates the plan of care regularly by chart review and patient interviews, as well as collaborates with the medical team to facilitate the patients' movement through the system.
  • Educate patients and families on the progression of care.
  • Serves as a liaison between patients, families, and healthcare personnel to ensure necessary care is provided promptly, effectively, and in a fiscally responsible manner.
  • Promotes quality care to ensure patients receive medically appropriate services in appropriate status and stay standards.
  • Facilitates regulatory notifications and patient signatures per policy.
  • Maintains knowledge regarding insurance reimbursement policies.
  • Relies on experience and judgement to plan and facilitate discharge and transition plans, and assures they meet the physical, social, and emotional needs of the patient.
  • Adheres to University and unit-level policies and procedures and safeguards University assets.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.
CORE QUALIFICATIONS
Education:
Bachelor's Degree in relevant field
Certification and Licensing:
Registered Nurse Licensing (RN)
Experience:
Minimum 7 years of relevant experience
(5 years of case management/utilization review experience)
Knowledge, Skills and Attitudes:
• Ability to communicate effectively in both oral and written form.
• Ability to recognize, analyze, and solve a variety of problems.
• Ability to analyze, organize and prioritize work under pressure while meeting deadlines.
• Ability to maintain effective interpersonal relationships.
The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.
UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.
The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.
Job Status:
Full time
Employee Type:
Staff

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About University of Miami

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The University of Miami, located in the beautiful Coral Gables, Florida, is a comprehensive, private research institution in the United States. Operating within the higher education industry, the institution offers a multitude of degree programs spanning over 180 majors and program through its 12 colleges. The University was founded in 1925 with the mission to disseminate knowledge, transform lives, and change the world - a mission it has held faithfully to this day. Notably, the University of Miami has gained global recognition for its commitment to research and innovation, with over $324 million in research and sponsored project funding awarded annually.

Industry

Colleges, universities, and professional schools

Company size

10,000+ Employees

Headquarters location

Coral Gables, FL, US

Year founded

1925

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