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Remote Utilization Review Rn Jobs in Scarborough, ME

Guardian Recovery

Clinical Intake Coordinator

Portland, ME · On-site +1

$60K - $80K/yr

This is a remote position designed to support and scale virtual services across the organization ... Registered Nurse certified as a Psychiatric Nurse, b. Advanced Practice Registered Nurse (APRN) ...

Guardian Recovery

Clinical Intake Coordinator

Portland, ME · On-site +1

$60K - $80K/yr

This is a remote position designed to support and scale virtual services across the organization ... Registered Nurse certified as a Psychiatric Nurse, b. Advanced Practice Registered Nurse (APRN) ...

Centene

Quality Care Member Advocate

Saco, ME · On-site +1

$27.02 - $48.55/hr

... - Registered Nurse - State Licensure and/or Compact State Licensure preferred Pay Range: $27.02 ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Centene

Quality Care Member Advocate

Portland, ME · On-site +1

$27.02 - $48.55/hr

... - Registered Nurse - State Licensure and/or Compact State Licensure preferred Pay Range: $27.02 ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Centene

Quality Care Member Advocate

Gorham, ME · On-site +1

$27.02 - $48.55/hr

... - Registered Nurse - State Licensure and/or Compact State Licensure preferred Pay Range: $27.02 ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Centene

Quality Care Member Advocate

Scarborough, ME · On-site +1

$27.02 - $48.55/hr

... - Registered Nurse - State Licensure and/or Compact State Licensure preferred Pay Range: $27.02 ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Scarborough, ME

Remote Utilization Review Rn information

See Scarborough, ME salary details

$22

$43

$71

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

As of Jul 27, 2026, the average hourly pay for remote utilization review rn in Scarborough, ME is $43.93, according to ZipRecruiter salary data. Most workers in this role earn between $34.71 and $50.43 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 Scarborough, ME? For Remote Utilization Review Rn jobs in Scarborough, ME, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Scarborough, ME look for? The top searched job categories for Remote Utilization Review Rn jobs in Scarborough, ME are:
What cities near Scarborough, ME are hiring for Remote Utilization Review Rn jobs? Cities near Scarborough, ME 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 Scarborough, ME as of July 2026, with employment types broken down into 72% Full Time, 8% Part Time, and 20% Contract. Highlights an 43% Physical, 3% Hybrid, and 54% Remote job distribution, with an average salary of $91,382 per year, or $43.9 per hour.
*Registered Nurse Centralized Services - Remote after onsite training in Portland

*Registered Nurse Centralized Services - Remote after onsite training in Portland

Martin's Point Health Care

Portland, ME • On-site, Remote

Full-time

Posted 3 days ago

Martin’s Point Health Care rating

7.4

Company rating: 7.4 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Job description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
The Central RN serves as a vital member of the centrally managed nursing team at Martin's Point Healthcare providing flexible, system-wide support across key functions including clinical triage, inbox management and care coordination. This role partners closely with all members of the care team to promote seamless care coordination and drive improved health outcomes for patients. The central RN must demonstrate adaptability and clinical expertise with flexibility to shift based on real-time demand and operational priorities.
Job Description
PRIMARY DUTIES AND RESPONSIBILITIES
Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.
  • Triages telephone calls applying standard protocols for patient care and recommendations dispositions
  • Evaluates patient symptoms, medical history and vital signs to triage patients in accordance with established guidelines and protocols to guide clinical decision making
  • Provides remote patient care, documentation and communication to patients and providers
  • Supports pre-visit planning and care coordination through summarizing patient needs and gaps for the visit, and updating the EMR as appropriate to include reconciliation of medications and ensuring appropriate orders are in place for the patient
  • Ensures that the provider has all the necessary clinical information about the patient prior to the visit, including clinical quality gaps, accurate diagnosis coding, and screenings that need to be addressed during the visit
  • Ensures timely and appropriate response to patient inquiries, test results, medication refills and other health related concerns communicated by the patient
  • Offers guidance and information to patients regarding their health concerns, treatment plans and self-care strategies through written and verbal communication
  • Maintains detailed and accurate records of all communications and actions taken in response to patient messages, ensuring compliance with best practices and regulatory requirements
  • Ensures accurate and timely documentation in the EMR, including scanning, per best practice guidelines and workflowsCoordinating care and services between providers and organizations to ensure that patient needs and preferences are met.
  • Promoting effective utilization of resources by facilitating and optimizing patient/member benefits.
  • Utilizing evidence-based guidelines and best practice care standards in clinical decision making and care management processes and interventions.
  • Educating patient/member and families to make informed personal health care decisions.
  • Meeting criteria for post-discharge outreach per organizational guidelines to support an effective intervention that results in reduction in readmission rates and integrity of health information during the transitional period.

POSITION QUALIFICATIONS
There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.
Education
  • Associate degree in Nursing
  • Bachelor's in nursing preferred

Licensure/certification
  • Current, unrestricted state Registered Nurse licensure
  • BLS required

Experience
  • 3+ years' experience in a clinical environment, preferably in a primary care setting
  • 5+ years' experience in a clinical environment, preferably in a primary care setting preferred
  • Telephone triage experience preferred

Knowledge
  • Knowledge of healthcare operations, especially in a primary care setting
  • Knowledge of quality measures and how to improve patient outcomes through quality gap closure
  • Understanding or interest in expanding knowledge of clinical quality measures (HEDIS) and coding concepts (CPT, ICD10, and HCC) preferred
  • Understanding of EHR documentation and quality reporting preferred

Skills
  • Strong critical thinking, problem-solving, and project management skills
  • Exceptional organizational, written and verbal communication, and attention to detail skills
  • Computer proficiency in Microsoft Office software
  • Proficient in working within an electronic medical record (EMR)

Abilities
  • Demonstrates an understanding of and alignment with Martin's Point Values
  • Ability to follow clinical protocols and standard workflows
  • Maintains patient confidentiality

This position is not eligible for immigration sponsorship.
We are an equal opportunity/affirmative action employer.
Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org
Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org

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