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Remote Utilization Review Rn Jobs in Philadelphia, PA

HealthSkil

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Fully Remote Registered Nurse (RN) Care Manager

Philadelphia, PA · Remote

$84K - $90K/yr

As an RN Care Manager, you will play a vital role in delivering holistic, patient-centered care ... with utilization review or risk management, technical proficiency with Microsoft Office ...

New

CVS Health

Case Manager, Registered Nurse

Trenton, NJ · Remote

$54K - $155K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

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 ...

Merakey

Remote RN - Part Time

Lafayette Hill, PA · Remote

Our Merakey affiliate is looking for a Part Time Remote RN to join the team. Part time - Remote Position $30.01 plus $3.00 shift diff for weekend and 3-11 shift. Hours: Thursday, 6a-2p, Friday 3p-11p ...

Merakey

LumiLink RN

Lafayette Hill, PA · On-site +1

The Remote LumiLink Registered Nurse is responsible for professionally answering LumiLink calls for health-related concerns for all contracted providers. This position is responsible for the ...

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 ...

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Remote Utilization Review Rn information

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$69

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

As of Jun 13, 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 is the meaning of the word remote?

In the context of a Remote Utilization Review RN job, 'remote' refers to working outside of a traditional office setting, often from home or another location of the employee's choice. This setup typically involves using digital tools and communication platforms to perform job duties without being physically present in an office environment.

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 meaning of remote in one word?

In the context of a Remote Utilization Review RN role, 'remote' means working from a location outside of a traditional office, typically from home, using digital communication tools. It emphasizes flexibility and virtual access to work systems without physical presence at a healthcare facility.

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.

How to make 2000 a week working from home?

A Remote Utilization Review RN can potentially earn $2,000 weekly by working full-time hours, often 40 hours per week, and gaining experience or certifications that allow for higher billing rates. Increasing income may involve taking on additional cases, specializing in high-demand areas, or working for agencies that offer competitive pay for remote utilization review roles.

What is remote job?

A remote Utilization Review RN job is a healthcare position where the nurse reviews patient cases and insurance claims from a location outside of a traditional office, often working from home. It requires strong communication skills, knowledge of medical documentation, and familiarity with electronic health record systems, with flexible schedules common in remote roles.

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:
What are popular job titles related to Remote Utilization Review Rn jobs in Philadelphia, PA? For Remote Utilization Review Rn jobs in Philadelphia, PA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Philadelphia, PA look for? The top searched job categories for Remote Utilization Review Rn jobs in Philadelphia, PA are:
What cities near Philadelphia, PA are hiring for Remote Utilization Review Rn jobs? Cities near Philadelphia, PA with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you

Utilization Review Clinician, Advocate, Remote

Social Work p.r.n.

Fort Washington, PA • Remote

Per diem

Posted 14 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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