ZipRecruiter

Log In

2

Remote Utilization Review Rn Jobs in Middletown, OH

Varsity Tutors

NCLEX-RN Tutor

Cincinnati, OH · 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 ...

Medpace, Inc.

Clinical Data Coder

Cincinnati, OH · On-site +1

$18 - $22.75/hr

Produce coding reports for team review and utilization *Stable schedule with no weekends, no work on Medpace holidays, and flexible work schedule* Qualifications * BSN and RN with applicable ...

Dove Recovery

Clinical Director

Cincinnati, OH · On-site +1

$76K - $104K/yr

Coordinate and collaborate with the contracted billing company and any internal utilization review ... Remote & Field-Based Work Expectations * Travel to assigned facility locations as needed for direct ...

Gentell

Certified Wound Care Clinician/Nurse

Dayton, OH · On-site +1

... utilization of wound care products - Understanding Medicare documentation and reimbursement ... (RN, LPN, PT, OTR-L, DPM or similar) preferred but could be certified in the first year of hire ...

next page

Showing results 1-20

All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Middletown, OH

Remote Utilization Review Rn information

See Middletown, OH salary details

$20

$40

$65

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

As of Sep 1, 2026, the average hourly pay for remote utilization review rn in Middletown, OH is $40.16, according to ZipRecruiter salary data. Most workers in this role earn between $31.73 and $46.11 per hour, depending on experience, location, and employer.

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 are the key skills and qualifications needed to thrive as a remote utilization review RN?

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 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 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 popular job titles related to Remote Utilization Review Rn jobs in Middletown, OH?

For Remote Utilization Review Rn jobs in Middletown, OH, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in Middletown, OH look for?

The top searched job categories for Remote Utilization Review Rn jobs in Middletown, OH are:

What cities near Middletown, OH are hiring for Remote Utilization Review Rn jobs?

Cities near Middletown, OH 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 Middletown, OH as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $83,526 per year, or $40.2 per hour.

Clinical Care Reviewer II - RN - IN MCD - IN or MSL Licensed

CareSource

Dayton, OH • On-site, Remote

$62K - $100K/yr

Full-time

Posted 7 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

208th of 315 rated insurance

Job description

Job Summary:
Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring the delivery of healthcare services.
Essential Functions:
  • Complete prospective, concurrent and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment
  • Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care
  • Engage with medical director when additional clinical expertise if needed
  • Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards
  • Identify and refer quality issues to Quality Improvement
  • Identify and refer appropriate members for Care Management
  • Provide guidance to non-clinical staff
  • Provide guidance and support to LPN clinical staff as appropriate
  • Attend medical advisement and State Hearing meetings, as requested
  • Assist Team Leader with special projects or research, as requested
  • Perform any other job related duties as requested.

Education and Experience:
  • Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required
  • Three (3) years clinical experience required
  • Med/surgical, emergency acute clinical care or home health experience preferred
  • Utilization Management/Utilization Review experience preferred
  • Medicaid/Medicare/Commercial experience preferred
Competencies, Knowledge and Skills:
  • Proficient data entry skills and ability to navigate clinical platforms successfully
  • Working knowledge of Microsoft Outlook, Word, and Excel
  • Effective oral and written communication skills
  • Ability to work independently and within a team environment
  • Attention to detail
  • Proper grammar usage and phone etiquette
  • Time management and prioritization skills
  • Customer service oriented
  • Decision making/problem solving skills
  • Strong organizational skills
  • Change resiliency
Licensure and Certification:
  • Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required
  • MCG Certification or must be obtained within six (6) months of hire required
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Travel is not typically required

Compensation Range:
$62,700.00 - $100,400.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Hourly
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-JM1
Brand=CareSource

What CareSource employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply