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Remote Utilization Review Rn Jobs in Miami, FL (NOW HIRING)

Varsity Tutors

NCLEX-RN Tutor

Doral, FL · Remote

$18 - $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

Miami Beach, FL · Remote

$18 - $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

Cooper City, FL · Remote

$18 - $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

Fort Lauderdale, FL · Remote

$18 - $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

Coral Gables, FL · Remote

$18 - $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

Sunrise, FL · Remote

$18 - $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

Hialeah, FL · Remote

$18 - $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

Miramar, FL · Remote

$18 - $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

Miami, FL · Remote

$18 - $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 ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Hollywood, FL · On-site +1

$52.25 - $63.75/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Miami, FL · On-site +1

$54.75 - $66.75/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

York Risk Services

RN Field Case Manager

Miami, FL · On-site +1

$74K - $94K/yr

... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...

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All JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Miami, FL

Remote Utilization Review Rn information

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$65

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.
What are popular job titles related to Remote Utilization Review Rn jobs in Miami, FL? For Remote Utilization Review Rn jobs in Miami, FL, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Miami, FL look for? The top searched job categories for Remote Utilization Review Rn jobs in Miami, FL are:
What cities near Miami, FL are hiring for Remote Utilization Review Rn jobs? Cities near Miami, FL with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Manager, Advanced Practice Practitioner (Remote FL)

Manager, Advanced Practice Practitioner (Remote FL)

Molina Healthcare

Miami, FL • Remote

$107K - $208K/yr

Full-time

Posted 27 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

143rd of 277 rated insurance

Job description

JOB DESCRIPTION Job Summary

This position will offer remote work flexibility but the selected individual will need to reside in Florida. 

Leads and manages team of advanced practice practitioners - focusing on clinical care implementation, quality assurance and internal/external relationship development to meet current and future member needs. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Leads team of nurse practitioners and physician assistants - ensuring quality clinical care for members that is cost-effective and person-centered.
Leads organizational efforts to ensure timely completion of deliverables assigned to the advanced practice team.
Serves as a representative for company at external workgroups and meetings, and provides advance practice representation.
Coordinates and facilitates advanced practice practitioner meetings, including developing agendas and arranging speakers.
Serves as liaison with staff, community clinicians and various internal departments to provide clinical care guidance and support for members.
Collaborates with internal departments and community partners on clinical care quality focused improvements, evaluation and initiatives.
Assists with implementation of key strategic organizational initiatives, focusing on clinical care and population health.
Participates in utilization management and develops strategies based upon fiscal utilization trends and patterns identified through data in regard to clinical care of members.
Establishes and maintains partnerships internally and externally to ensure appropriate utilization of services and knowledge surrounding member clinical care, including long-term care services.
Assists with policy, procedure and guideline development.
Provides direct supervision to assigned team and demonstrates accountability for performance.
Local travel may be required (based upon state/contractual requirements).

Required Qualifications

At least 7 years of experience in health care, including 5 or more years as a physician assistant or nurse practitioner working with the geriatric and/or disabled populations, or equivalent combination of relevant education and experience.
At least 1 year health care management/leadership experience.
Physician Assistant (PA) or Advanced Practice Registered Nurse (APRN) through American Nurses Credentialing Center (ANCC) or American Association of Nurse Practitioners (AANP). License must be active and unrestricted in state of practice.
Drug Enforcement Administration (DEA) license. License must be active and unrestricted in state of practice.
For nurse practitioner, must be a graduate of an accredited nurse practitioner program. For physician assistant, must be a graduate of an accredited physician assistant studies program
Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements.
Ability to share information effectively with a diverse population.
Ability to maintain schedules, meet deadlines and manage multiple projects.
Ability to think critically and demonstrate solution-oriented results in a fast-paced environment.
Ability to manage change, deal with situations as they arise, and work independently or as part of a team.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Medicaid and/or Medicare community-based program experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $107,028 - $208,705.4 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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