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Remote Utilization Review Rn Jobs in Philadelphia, PA

VIVA USA INC

Nurse Case Manager

Trenton, NJ · On-site +1

Fully remote (never coming onsite) ICM Case Manager RN Position Summary: Help us elevate our ... Uses clinical tools and information/data review to conduct an evaluation of member's needs and ...

InfoMC

Clinical Business Analyst

Conshohocken, PA · On-site +1

... utilization management (UM) and care management (CM) applications, acting as a trusted advisor to payer clients. This role requires candidates who are a Registered Nurse (RN) or licensed healthcare ...

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

As of Sep 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 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 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 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 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 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
Infographic showing various Remote Utilization Review Rn job openings in Philadelphia, PA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $88,746 per year, or $42.7 per hour.

Health Coach RN - remote (PA/NJ/DE)

Independence Blue Cross

Philadelphia, PA • On-site, Remote

Full-time

Re-posted 16 days ago

Key responsibilities

  • Provide health coaching and case management services to members across the continuum of health, including health promotion, acute symptoms, treatment decisions, and chronic conditions.

  • Collaborate on care plan development, screening, assessing, planning, monitoring, and adjusting care with members and physicians, while advocating for the member.

  • Support members in developing self-management skills, addressing barriers to adherence, and coordinating care with healthcare providers and resources.

Independence Blue Cross rating

8.8

Company rating: 8.8 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

57th of 315 rated insurance

Job description

Hours: FT, Mon-Fri 8:30-5p
Under the direction of the Care Management Manager, the Health Coach functions as the primary nurse to provide both health coaching and case management services to members across the continuum of health ranging from health promotion to end-of-life. Health coaches collaborate on care plan development and coordination with members and physicians by screening, assessing, planning, facilitating, monitoring and giving input when adjustment is needed, and advocating for the member on an individual basis. Health coaches use clinical and motivational interviewing skills to assess member's need and establish mutually agreeable goals while supporting member in developing self-management skills in adopting positive behavior changes. Health Coaches work with the member to identify and address barriers to member's adherence to standards of evidence-based medicine. The health coach facilitates communication between the patient, family, and members of the health care team while acting as an educator and link between the patient, providers and the plan, ensuring high quality, cost-effective services are delivered. Helps members coordinate care and navigate the healthcare system.
Duties and Responsibilities:
  • Functions as a primary nurse for members across the continuum of health and health-related services including information and support for lifestyle improvement, acute symptoms, treatment decisions, targeted health conditions, chronic conditions and complex conditions.
  • Engages with the members ranging from coaching to intensive case management with the goal to develop and support the member's ability to self-manage.
  • Provides appropriate clinical coaching support to members placing in-bound calls seeking assistance with acute symptoms, chronic conditions and/or health information regarding, specific topics.
  • Conducts appropriate surveys/assessments to proactively identify needs. Develops appropriate care plans and establishes goals. Assessment includes working with member/family/significant other to identify barriers of adherence to the physician's plan of care as well as achieving lifestyle improving goals. Continues to work with member via on-going telephonic communication to achieve the agreed upon goals.
  • Proactively incorporates lifestyle improvement and prevention opportunities into member interactions and coaching.
  • Contacts member's physician when needed especially in more complex medical situations requiring case management intervention to facilitate care coordination.
  • Monitors the quality of service, seeking member/family input. Communicates safety issues to manager and utilizes the occurrence screening for quality-of-care tracking.
  • Identifies on-line, telephonic and community-based resources that can assist the member in achieving and maintaining their personal health goals. Assist the member in accessing those services. In addition, assist in maximizing the use of member's benefits and ensuring coordination of services and outcomes.
  • Provides exceptional customer service.
  • Maintains and communicates accurate information in associate self-serve program.
  • Attends educational programs/training to maintain state license, CCMC licensure and updated knowledge of Health Coach process.
  • Ensures all activities are documented and conducted in compliance with applicable regulatory requirements and accreditation standards.
  • Other duties as assigned.

Qualifications:
  • Current, active, and unrestricted Pennsylvania (PA) or multi-state Registered Nurse licensure.
  • Three years any of combination of clinical, case management and/or disease/condition management experience.
  • Exceptional communication and problem-solving ability.
  • Ability to work flexible hours.
  • Basic computer skills.
  • Strong clinical knowledge.

  • Current, active, and unrestricted Pennsylvania (PA) Registered Nurse licensure.
  • Three years any of combination of clinical, case management and/or disease/condition management experience.
  • Exceptional communication and problem-solving ability.
  • Ability to work flexible hours.
  • Basic computer skills.
  • Strong clinical knowledge.

Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
At Independence Blue Cross, all qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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