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Remote Utilization Review Rn Jobs in Monaca, PA (NOW HIRING)

POCKET NURSE

Digital Media Coordinator

Monaca, PA · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... Nurse provides solutions and services that create hands-on learning experiences for the next ... Paid time off, personal time, paid holidays, and flexible hybrid onsite/remote work schedules.

Varsity Tutors

NCLEX-PN Tutor

Pittsburgh, PA · Remote

$18 - $40/hr

... RN scope questions, pharmacology calculations, and managing anxiety with the adaptive testing format. Adapts instruction using NCLEX-PN specific practice question banks, content review focused on ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Monaca, PA

Remote Utilization Review Rn information

See Monaca, PA salary details

$19

$38

$63

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

As of Aug 17, 2026, the average hourly pay for remote utilization review rn in Monaca, PA is $38.73, according to ZipRecruiter salary data. Most workers in this role earn between $30.62 and $44.47 per hour, depending on experience, location, and employer.

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 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 Monaca, PA?

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

What cities near Monaca, PA are hiring for Remote Utilization Review Rn jobs?

Cities near Monaca, PA 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 Monaca, PA as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $80,550 per year, or $38.7 per hour.

Client Success Associate - Remote

Care Options for Kids

Pittsburgh, PA • On-site, Remote

$23 - $25/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 2 days ago

Job description

At Care Options for Kids, we are committed to providing the highest quality of service, delivering excellence in everything we do, and maintaining integrity in every interaction.
The Client Success Associate is responsible for managing the end-to-end referral and admission process for patients requiring private duty nursing services in the home. This role ensures timely, accurate, and compliant intake operations while serving as a key liaison among referral sources, patients and families, clinical teams, and payers.
Client Success Associate responsibilities include, but are not limited to:
  • Receive and manage incoming referrals from hospitals, physicians, case managers, managed care organizations, and community partners.
  • Coordinate and manage all new patient intakes from referral through admission and service activation.
  • Review referral documentation for completeness and accuracy, and enter all required information into the EMR.
  • Verify patient eligibility, benefits, and insurance coverage, including Medicaid and commercial insurance plans.
  • Obtain, submit, and track authorization requests and Single Case Agreements from initiation through execution.
  • Serve as the primary point of contact for patients, families, and referral sources regarding services, rates, admission status, and available community resources.
  • Maintain ongoing communication and provide timely updates to referral sources, families, and internal team members regarding intake status and service readiness.
  • Ensure compliance with agency policies, regulatory requirements, payer guidelines, and documentation standards.
  • Complete assigned Intake Workflow tasks within the EMR and identify opportunities to improve intake processes and operational efficiency.
  • Track and maintain accurate intake records, metrics, and reporting data to support departmental performance goals.

Qualifications:
  • Associate degree required; bachelor's degree preferred.
  • Minimum of two years of experience in healthcare intake, admissions, care coordination, home health, private duty nursing (PDN), or managed care preferred.
  • Knowledge of insurance verification, authorization processes, Medicaid programs, managed care organizations, Single Case Agreements, and health plans related to PDN services preferred.
  • Strong organizational, communication, and interpersonal skills.
  • Proficiency with EMR systems and Microsoft Office applications, including Outlook and Excel.
  • Ability to communicate effectively in English, both verbally and in writing; bilingual skills are a plus but not required.
  • Ability and willingness to travel occasionally (up to 10%) for team meetings, training, conferences, and other business-related events as needed.
Care Options for Kids offers benefits to variable paid employees based on certain measurement periods. These benefits are available to eligible employees and are designed to support the health and well-being of you and your family.
Location:Remote in Pennsylvania, New Jersey or Delaware
Wage:$23.00 to $25.00/hour
Benefits include:
  • Paid time off
  • Medical, dental and vision
  • 401K
  • Other voluntary products

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