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Remote Utilization Review Rn Jobs in Morris County, NJ

HURC

UR Clinical Operations Lead

Short Hills, NJ · Remote

Position Summary The Utilization Review (UR) Clinical lead serves as a subject matter expert in ... Registered Nurse (RN) required; BSN preferred. * Advanced degree (MSN, MHA, MBA) preferred.

VNA Health Group

RN OASIS Reviewer

Tinton Falls, NJ · Remote

$40 - $52/hr

Clinical Data Coordinator/OASIS Review VNA Health Group Remote Per Diem This position requires ... Current NJ RN License required * BSN preferred * OASIS Certified or actively pursuing OASIS ...

Hurc LLC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

National Nurse Triage Inc

THIS IS A REMOTE POSITION Part Time/Contract Position DUTIES: -Assess patient health problems over ... Registered Nurse; preferably in the ICU, ED, Mother/Baby unit, Peds, Home Health & Hospice ...

National Nurse Triage Inc

THIS IS A REMOTE POSITION Part Time/Contract Position DUTIES: -Assess patient health problems over ... Registered Nurse; preferably in the ICU, ED, Mother/Baby unit, Peds, Home Health & Hospice ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Morris County, NJ

Remote Utilization Review Rn information

See Morris County, NJ salary details

$21

$43

$70

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

As of Aug 2, 2026, the average hourly pay for remote utilization review rn in Morris County, NJ is $43.40, according to ZipRecruiter salary data. Most workers in this role earn between $34.28 and $49.86 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 cities near Morris County, NJ are hiring for Remote Utilization Review Rn jobs? Cities near Morris County, NJ with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you

UR Clinical Operations Lead

HURC

Short Hills, NJ • Remote

Full-time

Re-posted 16 days ago

Job description

Position Summary

The Utilization Review (UR) Clinical lead serves as a subject matter expert in utilization management and hospital revenue cycle operations. This role partners directly with large hospital systems to assess, optimize, and support utilization review and denial management initiatives.

The ideal candidate is a licensed clinician with strong utilization review experience and the ability to work directly with executive and operational leaders within healthcare organizations. This position requires a consultative mindset, excellent communication skills, and the ability to influence change while driving measurable outcomes for clients.


Essential Responsibilities

  • Serve as the primary clinical consultant for assigned hospital and health system clients.
  • Build and maintain strong relationships with client leadership, including Case Management Directors, Revenue Cycle Leaders, Physician Advisors, and C-suite executives.
  • Conduct assessments of utilization review processes and identify opportunities for operational improvement.
  • Provide strategic recommendations to improve authorization processes, reduce denials, and optimize reimbursement.
  • Facilitate client meetings, present findings, and communicate project updates to stakeholders.
  • Support implementation of process improvements and monitor performance metrics.
  • Review inpatient and outpatient utilization management processes for compliance and efficiency.
  • Analyze denial trends, payer behavior, and utilization patterns.
  • Collaborate with physician advisors and operational teams to improve medical necessity documentation and appeal success rates.
  • Provide guidance on CMS, Medicare, Medicaid, and commercial payer requirements.
  • Assist clients with length-of-stay management, authorization processes, and denial prevention strategies.
  • Develop and implement best practices related to utilization management and revenue integrity.
  • Educate client teams on regulatory changes, payer requirements, and industry best practices.
  • Develop training materials, workflows, and standard operating procedures.
  • Mentor and support internal consultants and clinical team members.
  • Serve as a subject matter expert during client engagements and business development opportunities.


Experience

  • Minimum of 7 years of Utilization Review, Case Management or Revenue Cycle experience.
  • Minimum of 3 years working directly with hospital systems in a consulting or client-facing capacity.
  • Strong understanding of:
    • Hospital revenue cycle operations
    • Utilization management
    • Denial management
    • Medical necessity criteria
    • Payer regulations and reimbursement methodologies
    • Experience presenting in executive leadership and facilitating client meetings.


Knowledge & Skills

  • Strong knowledge of Medicare, Medicaid, and commercial payer requirements.
  • Experience with electronic medical records, preferably Epic.
  • Excellent presentation and communication skills.
  • Ability to build credibility and influence stakeholders at all levels.
  • Strong analytical and problem-solving abilities.
  • Self-directed with the ability to manage multiple client engagements simultaneously.
  • Proficiency in Microsoft Office applications, particularly Excel and PowerPoint.

Qualifications

Education

  • Registered Nurse (RN) required; BSN preferred.
  • Advanced degree (MSN, MHA, MBA) preferred.


Licensure

  • Active, unrestricted RN license required.

Travel Requirements

  • Up to 25% travel, as required by client engagements.

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