ZipRecruiter

Log In

2

Remote Utilization Review Rn Jobs in Suffolk County, NY

Phaxis

AIMS- REMOTE RN CARE MANAGER

NY · On-site +1

$61 - $63/hr

... appropriate utilization of services. This role supports patients across the continuum of care ... Current NYS RN license * Experience in case management, care coordination, or similar clinical ...

Mercor

Utilisation Management Expert - RN

New York, NY · Remote

$100 - $150/hr

Remote Role Responsibilities * Lead utilisation management and case management operations ... Conduct and oversee clinical reviews against InterQual , MCG , or Milliman care guidelines to ...

previous pagenext page

Showing results 21-40

All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Suffolk County, NY

Remote Utilization Review Rn information

See Suffolk County, NY salary details

$22

$45

$73

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

As of Aug 7, 2026, the average hourly pay for remote utilization review rn in Suffolk County, NY is $45.29, according to ZipRecruiter salary data. Most workers in this role earn between $35.77 and $52.02 per hour, depending on experience, location, and employer.

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 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 cities near Suffolk County, NY are hiring for Remote Utilization Review Rn jobs? Cities near Suffolk County, NY 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 Suffolk County, NY as of August 2026, with employment types broken down into 82% Full Time, 6% Part Time, and 12% Contract. Highlights an 100% Remote job distribution, with an average salary of $94,207 per year, or $45.3 per hour.

Associate Medical Director, Utilization Management

Oscar Health

New York, NY • Remote

$240K - $315K/yr

Full-time

Medical, Retirement, PTO

Posted 9 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

251st of 303 rated insurance

Job description

Hi, we're Oscar. We're hiring an Associate Medical Director to join our Utilization Management Team. 

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family.

About the role:

This role determines the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This role also influences departmental strategy, leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards.

You will report into the Senior Medical Director.

Work Location: This is a remote position, open to candidates holding an active medical license in Florida, Arizona or North Carolina, OR to physicians who hold an IMLC compact license. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $240,120 - $315,157 annually. You are also eligible for employee benefits including a performance bonus, 401K with immediate vesting, and unlimited PTO. 

Responsibilities:

  • Provide timely medical reviews that meet Oscar's stringent quality parameters.

  • Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.

  • Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level).

  • Use correct templates for documenting decisions during case review.

  • Receive and review escalated reviews.

  • Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.

  • Manage direct reports and oversee their performance.

  • Provide oversight to ensure the team meets turn-around times for clinical reviews.

  • Collaborate with other departments on Utilization Management Operations.

  • Lead key projects and drive initiatives to successful completion.

  • Other duties as assigned

  • Compliance with all applicable laws and regulations.ocus on the main or important responsibilities))

Requirements:

  • Board certification as an MD or DO with a current unrestricted license to practice medicine is required.

  • 3+ years of clinical practice

  • 2+ years of utilization review experience in a managed care plan (health care industry)

Bonus points:

  • Licensure in multiple Oscar states

  • Experience with care management within the health insurance industry.

  • Willing and able to obtain additional state licensure as business needs, with Oscar's support

What Oscar Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply