ZipRecruiter

Log In

2

Remote Utilization Review Rn Jobs in Murfreesboro, TN

Vertek Staffing

CDI Specialist

Franklin, TN · Remote

$33.50 - $45/hr

Required: * Active, unrestricted Registered Nurse (RN) license Preferred Certifications ... The CDI Specialist will work collaboratively with HIM, Coding, Case Management, Utilization Review ...

Elevance Health

Remote Triage - RN

Nashville, TN · On-site +1

Remote Triage - RN *Candidates with a compact license strongly preferred* Shift: Rotating schedule ... Reviews members current labs and medications for appropriateness. Minimum requirements: * Requires ...

VIVA USA INC

Nurse Case Manager

Nashville, TN · On-site +1

... utilization management to members. Performs prospective, concurrent, and retrospective reviews for ... team members. RN and current unrestricted nursing license required. Notes: This is a remote ...

next page

Showing results 1-20

All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Murfreesboro, TN

Remote Utilization Review Rn information

See Murfreesboro, TN salary details

$19

$38

$62

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

As of Jul 18, 2026, the average hourly pay for remote utilization review rn in Murfreesboro, TN is $38.11, according to ZipRecruiter salary data. Most workers in this role earn between $30.10 and $43.75 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 Murfreesboro, TN? For Remote Utilization Review Rn jobs in Murfreesboro, TN, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Murfreesboro, TN look for? The top searched job categories for Remote Utilization Review Rn jobs in Murfreesboro, TN are:
What cities near Murfreesboro, TN are hiring for Remote Utilization Review Rn jobs? Cities near Murfreesboro, TN 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 Murfreesboro, TN as of July 2026, with employment types broken down into 2% As Needed, 73% Full Time, 16% Part Time, and 9% Contract. Highlights an 100% Remote job distribution, with an average salary of $79,262 per year, or $38.1 per hour.

VP of Utilization Review

ODYSSEY BEHAVIORAL GROUP

Franklin, TN • On-site, Remote

Full-time

Re-posted 19 days ago

Job description

Position Summary
The Vice President of Utilization Review (VP of UR) provides strategic and operational leadership for the enterprise-wide Utilization Review function across all behavioral health service lines and levels of care. This executive leader is responsible for developing, standardizing, optimizing, and overseeing utilization management practices that support quality care, appropriate reimbursement, regulatory compliance, payer relationships, and organizational financial performance.
The VP of UR partners closely with Executive Leadership, Clinical Operations, Revenue Cycle, Admissions, Nursing, Compliance, Business Development, and Finance to ensure utilization management processes align with organizational goals, evidence-based practices, and payer requirements. This role is responsible for driving performance improvement initiatives related to authorizations, denials management, length of stay optimization, appeals, documentation integrity, and payer strategy.
The VP of UR serves as the enterprise subject matter expert for utilization management and develops scalable systems, reporting structures, KPIs, and accountability processes to support continued organizational growth and operational excellence.
Relationships and Contacts
Within the organization: Maintains frequent and collaborative working relationships with the Chief Clinical Officer, Executive Leadership, Divisional CEOs, Chief Financial Officer, Revenue Cycle leadership, Business Development, Admissions, Nursing leadership, Medical leadership, Compliance, Risk Management, Operations leadership, and all clinical team members across the organization.
Outside the organization: Develops and maintains strategic relationships with insurance organizations, managed care companies, external review organizations, payer representatives, referral partners, vendors, and consultants, as appropriate.
Position Responsibilities
Essential Responsibilities
  1. Provides executive oversight and strategic direction for all enterprise Utilization Review operations across multiple facilities, service lines, and states.
  2. Develops and implements standardized enterprise-wide UR processes, workflows, policies, and documentation standards to improve operational consistency and payer outcomes.
  3. Oversees authorization management, concurrent review processes, denial prevention strategies, appeals management, retrospective reviews, and payer escalation processes.
  4. Partners with Clinical, Nursing, Admissions, and Revenue Cycle teams to ensure documentation supports medical necessity, level of care determinations, and reimbursement optimization.
  5. Develops enterprise KPI dashboards and reporting structures related to denials, overturn rates, authorization timeliness, payer trends, reimbursement performance, length of stay management, and utilization efficiency.
  6. Identifies trends, gaps, and opportunities within utilization management processes and leads performance improvement initiatives to enhance operational and financial outcomes.
  7. Collaborates with executive leadership regarding payer contracting strategy, authorization challenges, network access issues, and value-based care initiatives.
  8. Serves as an organizational expert regarding payer requirements, medical necessity criteria, utilization management regulations, and behavioral health reimbursement practices.
  9. Oversees recruitment, onboarding, training, mentorship, performance management, and leadership development for enterprise UR leadership and staff.
  10. Conducts regular audits and quality reviews to ensure compliance with regulatory requirements, payer expectations, and organizational standards.
  11. Develops escalation pathways and support structures for complex cases, difficult payer interactions, and high-risk authorization issues.
  12. Leads enterprise education initiatives related to documentation integrity, medical necessity standards, payer trends, and authorization best practices.
  13. Collaborates with Information Technology and EHR leadership to optimize utilization review workflows, reporting capabilities, automation opportunities, and data integrity.
  14. Supports organizational growth initiatives, acquisitions, new program development, and expansion strategies through scalable utilization management processes.
  15. Participates in executive meetings, operational reviews, and strategic planning initiatives as a key organizational leader.
  16. Maintains strict confidentiality of all company, departmental, patient, payer, and healthcare provider information.
  17. Reports enterprise risks, payer concerns, and operational barriers to executive leadership with recommendations for resolution and mitigation.

Education and Experience
Bachelor's degree required, master's degree in nursing, Healthcare Administration, Business Administration, or related healthcare field preferred. Clinical licensure preferred (RN, LCSW, LPC, LMFT, or comparable behavioral health licensure). Requires a minimum of seven (7) years of progressive Utilization Review leadership experience within behavioral health, including large multi-site or enterprise oversight responsibilities. Previous experience developing KPIs, reporting analytics, dashboards, and executive-level operational presentations is required.
Physical Requirements
  • While performing the duties of this job, the employee must communicate with internal and external stakeholders and vendors.
  • Tolerant to various noise levels: noise level in the work environment varies - may be quiet to moderate noise levels.
  • Job performance will require the ability to move throughout the building as well as sit or remain stationary for extended periods of time.
  • While performing the duties of this job, the employee may be required to talk or hear, sit, stand, walk, and reach.
  • Ability to travel by various forms of transportation, including automobiles and airplane.

Additional Requirements
  • Position requires incumbent to have a valid driver's license and acceptable driving record.
  • Clearance of TB test, and any other mandatory state/federal requirements.

Skill Competencies
  • Demonstrates executive leadership and strategic planning capabilities.
  • Demonstrates the ability to lead enterprise-wide operational change and process improvement initiatives.
  • Demonstrates extensive knowledge of behavioral health levels of care, medical necessity criteria, payer operations, reimbursement methodologies, and regulatory requirements.
  • Demonstrates experience leading large-scale operational improvement initiatives and enterprise standardization efforts.
  • Demonstrates a strong understanding of managed care contracting, denial management, appeals processes, and payer negotiation strategies.
  • Demonstrates strong financial acumen with understanding of reimbursement, payer strategy, and revenue optimization.
  • Demonstrates ability to successfully function under pressure in critical and rapidly changing situations.
  • Demonstrates ability to effectively manage conflict, escalation, and crisis situations.
  • Demonstrates strong analytical, problem-solving, and decision-making skills.
  • Demonstrates exceptional organizational and project management skills.
  • Demonstrates excellent interpersonal, relationship-building, and executive communication skills.
  • Demonstrates the ability to influence cross-functional teams and build organizational alignment.
  • Demonstrates a prominent level of discretion, professionalism, and accountability.
  • Demonstrates strong diligence and follow-through.
  • Demonstrates proficiency with Microsoft Office programs, reporting systems, EHR platforms, and data analytics tools.
  • Consistently demonstrates and models alignment with company mission, values, and leadership expectations.

Odyssey Behavioral Healthcare, LLC provides equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunities apply to all terms and conditions of employment. Odyssey reserves the right to modify, interpret, or apply this job description in any way the organization desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities. This job description is not an employment contract, implied or otherwise. The employment relationship remains "At-Will."

Apply