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Remote Utilization Review Rn Jobs in Philadelphia, PA

Novacore

Medical Review Nurse

Conshohocken, PA · Remote

The Medical Review Nurse is a registered nurse who can assist Novacore's Claim and Underwriting ... Ability to work independently in a remote setting. * Ability to work with multiple offices and ...

Dane Street

Radiology - Imaging Physician

Philadelphia, PA · Remote

$322K - $403K/yr

... Record Reviews. This is a fully remote opportunity offering flexible scheduling, allowing you to ... Enhanced industry expertise in medical necessity, utilization review, and claims support * Expanded ...

Varsity Tutors

NCLEX-RN Tutor

Trenton, NJ · 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 ...

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Remote Utilization Review Rn information

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$42

$69

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 Philadelphia, PA is $42.67, according to ZipRecruiter salary data. Most workers in this role earn between $33.70 and $48.99 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 the most commonly searched types of Utilization Review Rn jobs in Philadelphia, PA? The most popular types of Utilization Review Rn jobs in Philadelphia, PA are:
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Remote Utilization Review Rn jobs near you
Utilization Review Clinician, Advocate, Remote

Utilization Review Clinician, Advocate, Remote

Social Work p.r.n.

Fort Washington, PA • Remote

Per diem

Posted 8 days ago

Job description

Utilization Review Clinician/Advocate needed for remote Per Diem position.

The Utilization Review Clinician/Advocate provides telephonic care review and authorization determinations for psychiatric, and substance use treatment services, including prospective, concurrent, and discharge reviews. This role evaluates appropriate levels of care based on medical necessity criteria, collaborates with treatment teams and Physician Advisors regarding authorization decisions and alternative treatment options, and provides members and providers with information on behavioral health benefits and community resources.

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