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Remote Utilization Review Rn Jobs in Somerville, MA

Sedgwick

RN Field Case Manager

Boston, MA · Remote

$84K - $107K/yr

Must be an RN and prefers 1.5 years of prior workers compensation experience. PRIMARY PURPOSE OF ... remote work environment that allows face to face interaction with injured workers and medical ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Boston, MA · On-site +1

$62.25 - $75.75/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 ...

York Risk Services

RN Field Case Manager

Boston, MA · Remote

$84K - $107K/yr

Must be an RN and prefers 1.5 years of prior workers compensation experience. PRIMARY PURPOSE OF ... remote work environment that allows face to face interaction with injured workers and medical ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Cambridge, MA · On-site +1

$62.25 - $75.75/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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$23

$46

$75

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

As of Jun 27, 2026, the average hourly pay for remote utilization review rn in Somerville, MA is $46.14, according to ZipRecruiter salary data. Most workers in this role earn between $36.44 and $52.98 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 popular job titles related to Remote Utilization Review Rn jobs in Somerville, MA? For Remote Utilization Review Rn jobs in Somerville, MA, the most frequently searched job titles are:
What cities near Somerville, MA are hiring for Remote Utilization Review Rn jobs? Cities near Somerville, MA with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Group Health Operations Manager

Group Health Operations Manager

Dane Street, LLC

Boston, MA • Remote

$75K - $93K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted yesterday

Job description

100% REMOTE

JOB SUMMARY

Oversee and ensure the overall profitability of the regional operations center. This includes but is not limited to reaching and exceeding financial & referral goals, properly managing staffing efficiencies throughout the team, managing performance expectations & improvements for existing staff. Present management with regular reporting on any topic requested by the management team.

Dane Street's success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

MAJOR DUTIES & RESPONSIBILITIES

Driving Revenue Growth

  • The Operations Manager drives revenue growth by delivering excellent Customer service.
    • This includes meeting scheduling best practices and turnaround time requirements.
    • Ensuring the timely delivery of high quality reports.
  • Managing client inquiries in a timely manner.

Optimizing Physician cost

  • Ensuring that client invoices adhere to the agreed upon fee schedule.
  • Overseeing the proper selection of physicians. 
  • Specifically ensuring that the team selects the most appropriate physician based on the claimant's location, the required specialty, and the most appropriately priced physician based on the client's fee schedule.
  • Building relationships with key physicians to ensure panel retention.

  Manage Staff Performance and capacity

  • Monitor key performance metrics of individual Customer Service Representatives (CSR) and Quality Assurance (QA) Specialists.
  • Ensure the team meets or exceeds 85% of output goals for scheduling and Quality Assurance targets.
  • Responsible for hiring new staff members based on increased referral volume and/or the addition of new clients.
  • Conducts performance evaluations that are timely and constructive.
  • Handles discipline and termination of employees as needed and in accordance with company policy.
  • Responsible for the overall production, performance, and quality of the assigned region.  
    • Plans and organizes daily activities related to production and operations.
    • Measures productivity by analyzing performance data, financial data, and activity reports.
    • Coordinates with other support departments such as human resources, finance, and IT and BA to ensure successful production operations.
    • Determines labor needs to meet production goals.

Requirements

EDUCATION/CREDENTIALS:

  • An Associate's Degree or Bachelor's Degree is preferred.
  • RN / LPN License is required.

JOB RELEVANT EXPERIENCE:

  • Business experience in a healthcare and/or insurance setting is preferred.
  • Business experience in a Worker's Compensation and/or Auto insurance setting is preferred.
  • Utilization Review experience is required.

JOB RELATED SKILLS/COMPETENCIES:

  • Present exceptional communication skills with a clear understanding of company business lines.
  • The ability to apply critical thinking, manage time efficiently and meet specific deadlines. Computer literacy and typing skills are essential.

WORK FROM HOME TECHNICAL REQUIREMENTS:

  • Supply and support their own internet services.
  • Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.

Our Commitment:

We are committed to providing fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees.

Compensation Range: $75,000 - $93,750 USD

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace. 

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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