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Remote Utilization Review Rn Jobs in Reno, NV (NOW HIRING)

Molina Healthcare

Medical Review Nurse (RN)

Reno, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...

Molina Healthcare

Medical Review Nurse (RN)

Reno, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...

CVS Health

Case Manager, Registered Nurse

Carson City, NV · Remote

$54.10K - $155.54K/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 ...

CVS Health

Case Manager, Registered Nurse

Carson City, NV · Remote

$54.10K - $155.54K/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 ...

Pine Park Health

Remote Registered Nurse (RN)

Reno, NV · Remote

As an RN in our new team, you will be the hub of our care team structure and model of care. You ... Strong experience in remote roles, showcasing proficiency with technology and digital communication ...

Pine Park Health

Remote Registered Nurse (RN)

Reno, NV · Remote

As an RN in our new team, you will be the hub of our care team structure and model of care. You ... Strong experience in remote roles, showcasing proficiency with technology and digital communication ...

Pine Park Health

Remote Registered Nurse (RN)

Reno, NV · On-site +1

As an RN in our new team, you will be the hub of our care team structure and model of care. You ... Strong experience in remote roles, showcasing proficiency with technology and digital communication ...

Renown Health

Transfer Center and Virtual Care RN

Reno, NV · On-site +1

$34.67 - $52.01/hr

Position Purpose The Transfer Center & Virtual Care RN provides leadership, accountability, and comprehensive nursing services to ensure optimal patient care, resource utilization, and seamless ...

Renown Health

Transfer Center and Virtual Care RN

Reno, NV · On-site +1

$34.67 - $52.01/hr

Position Purpose The Transfer Center & Virtual Care RN provides leadership, accountability, and comprehensive nursing services to ensure optimal patient care, resource utilization, and seamless ...

Renown Health

Transfer Center and Virtual Care RN

Reno, NV · On-site +1

$34.67 - $52.01/hr

Position Purpose The Transfer Center & Virtual Care RN provides leadership, accountability, and comprehensive nursing services to ensure optimal patient care, resource utilization, and seamless ...

Corvel

Medical Case Manager II

Reno, NV · On-site +1

$65.44K - $98.98K/yr

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Varsity Tutors

NCLEX-RN Tutor

Reno, NV · Remote

$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 ...

DataAnnotation

Registered Nurse

Sparks, NV · Remote

$40 - $60/hr

MDs, PAs, and Nurses. Benefits ... This a full-time or part-time REMOTE position * You'll be able to choose which projects you want to ...

DataAnnotation

RN

Reno, NV · Remote

$40 - $60/hr

MDs, PAs, and Nurses. Benefits ... This a full-time or part-time REMOTE position * You'll be able to choose which projects you want to ...

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Remote Utilization Review Rn information

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$42

$68

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

As of May 28, 2026, the average hourly pay for remote utilization review rn in Reno, NV is $42.16, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.41 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 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 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 popular job titles related to Remote Utilization Review Rn jobs in Reno, NV? For Remote Utilization Review Rn jobs in Reno, NV, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Reno, NV look for? The top searched job categories for Remote Utilization Review Rn jobs in Reno, NV are:
What cities near Reno, NV are hiring for Remote Utilization Review Rn jobs? Cities near Reno, NV 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 Reno, NV as of May 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $87,689 per year, or $42.2 per hour.
Medical Review Nurse (RN)

Medical Review Nurse (RN)

Molina Healthcare

Reno, NV • Remote

$30.50 - $59.47/hr

Full-time

Posted 21 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

147th of 258 rated insurance

Job description

Job Description

Job Summary

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. 

 
Job Duties
  • Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. 
  • Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions.
  • Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. 
  • Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues.
  • Identifies and reports quality of care issues.
  • Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience.
  • Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings.                                                                   
  • Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. 
  • Supplies criteria supporting all recommendations for denial or modification of payment decisions.
  • Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. 
  • Provides training and support to clinical peers. 
  • Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols.
 
Job Qualifications
REQUIRED QUALIFICATIONS:
  • At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. 
  • Registered Nurse (RN) in Nevada. License must be active and unrestricted in state of practice. 
  • Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC).
  • Experience working within applicable state, federal, and third-party regulations.
  • Analytic, problem-solving, and decision-making skills.              
  • Organizational and time-management skills.
  • Attention to detail.
  • Critical-thinking and active listening skills. 
  • Common look proficiency.
  • Effective verbal and written communication skills.
  • Microsoft Office suite and applicable software program(s) proficiency.
PREFERRED QUALIFICATIONS:
  • Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications.
  • Utilization Management Experience
  • Experience with MCG, PEGA and/or Salesforce  
  • Billing and coding experience.
 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.  
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $30.5 - $59.47 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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