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Remote Utilization Review Rn Jobs in Rochester Hills, MI

Strategic Staffing Solutions

Case Manager-RN

Detroit, MI · Remote

$40/hr

Remote, Detroit, MI (Remote) Duration: 12 Month Contract Pay: Up to $40/hr Overview: The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care ...

HarmonyCares

Clinical Triage Nurse, RN

Troy, MI · On-site +1

$36.45/hr

The Clinical Triage Nurse, RN also reviews clinical test results, utilizing clinical judgement to summarize results to assist providers in their review process. This position requires strong clinical ...

HarmonyCares

Clinical Triage Nurse, RN

Troy, MI · Remote

The Clinical Triage Nurse, RN also reviews clinical test results, utilizing clinical judgement to summarize results to assist providers in their review process. This position requires strong clinical ...

HarmonyCares

Clinical Triage Nurse, RN

Troy, MI · On-site +1

$36.45/hr

The Clinical Triage Nurse, RN also reviews clinical test results, utilizing clinical judgement to summarize results to assist providers in their review process. This position requires strong clinical ...

HarmonyCares

Clinical Triage Nurse, RN

Troy, MI · Remote

The Clinical Triage Nurse, RN also reviews clinical test results, utilizing clinical judgement to summarize results to assist providers in their review process. This position requires strong clinical ...

Varsity Tutors

NCLEX-RN Tutor

Detroit, MI · 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 ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Detroit, MI · On-site +1

$52.50 - $63.75/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

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Remote Utilization Review Rn information

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

As of Jun 11, 2026, the average hourly pay for remote utilization review rn in Rochester Hills, MI is $38.92, according to ZipRecruiter salary data. Most workers in this role earn between $30.77 and $44.71 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 Rochester Hills, MI? For Remote Utilization Review Rn jobs in Rochester Hills, MI, the most frequently searched job titles are:
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What cities near Rochester Hills, MI are hiring for Remote Utilization Review Rn jobs? Cities near Rochester Hills, MI with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Remote Case Manager RN (Compact License Required) - Contract to Hire

Remote Case Manager RN (Compact License Required) - Contract to Hire

G-TECH Services

Detroit, MI • Remote

$33.50 - $36/hr

Full-time

Medical, Dental, Vision, PTO

Posted 5 days ago

Job description

Remote Case Manager RN (Compact License Required) – Contract to Hire

Department: BCCC Commercial Operations
Location: 100% Remote
Schedule: Full-Time

Position Overview

The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person-centric care management program to a diverse health plan population with a variety of health and social needs.

Serves as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages, and the online messaging platform.

Uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member’s health across the care continuum.

Schedule & Requirements

  • Fully remote – no onsite requirement
  • Must live in an approved Compact State and hold a Multistate License
  • Working hours up to 8:00 PM EST may be expected
  • No vacation allowed during the first 8 weeks of training
  • Duration: 1-year contract to hire

Approved States (Must Reside In):

Colorado, Georgia, Indiana, Kentucky, Mississippi, Ohio, Pennsylvania, Virginia, Washington, Louisiana, Iowa

Key Responsibilities

  • Lead coordination of a multidisciplinary care team including Social Workers, Dietitians, Pharmacists, Clinical Support Staff, and Medical Directors
  • Assess member health, psychosocial needs, cultural preferences, and support systems
  • Develop and implement individualized care plans in partnership with members and providers
  • Identify gaps in care and address barriers to improve health outcomes
  • Coordinate care delivery with providers, community agencies, and family support systems
  • Arrange resources including community services, mental health support, and disease-specific programs
  • Provide education on health literacy, medication plans, nutrition, and self-management
  • Monitor and evaluate care plan effectiveness and adjust as needed
  • Document all member interactions accurately
  • Support discharge planning and care transitions between facilities and home
  • Coordinate transportation, durable medical equipment, and follow-up care

Education & Experience

  • Bachelor’s Degree in Nursing required
  • 3 years of clinical nursing experience required
  • 1 year of case management experience preferred
  • Experience managing patients telephonically and digitally preferred

Licenses & Certifications

  • Active, unrestricted Multistate Compact RN License required
  • CCP and Case Management certifications preferred

Skills & Qualifications

  • Critical thinking and problem-solving ability
  • Strong communication and interpersonal skills
  • Organizational and time management skills
  • Ability to manage multiple systems and tools simultaneously
  • Proficiency in Microsoft Office (Excel, Outlook, Teams, Word)
  • Ability to work independently and within a team environment

Compensation Options

  • $33.50/hour – 10 days PTO, 6 paid holidays, medical, dental, and vision
  • $34.50/hour – 10 days PTO, no holidays, medical, dental, and vision
  • $35.00/hour – 10 days PTO, 6 holidays, no medical
  • $36.00/hour – 9 days PTO only

Company Description

Why work at G-Tech?
G-Tech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at G-Tech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today!
G-Tech is an Equal Opportunity Employer (EOE), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
By submitting your application, you acknowledge that recruiting technologies, including AI-assisted tools, may be used to support candidate evaluation, sourcing, matching, and communications.