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Remote Utilization Review Rn Jobs in Warren, OH (NOW HIRING)

ProLocums

Radiology Locum job in Youngstown, OH

Youngstown, OH · Remote

$2.40K - $3.16K/wk

We are seeking a Diagnostic Radiologist for an ongoing, remote overnight assignment. This position offers a premium "work-from-home" schedule with an incredible 1:2 rotation, allowing for significant ...

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Remote Utilization Review Rn information

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$18

$36

$59

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 Warren, OH is $36.36, according to ZipRecruiter salary data. Most workers in this role earn between $28.75 and $41.73 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 Warren, OH? For Remote Utilization Review Rn jobs in Warren, OH, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Warren, OH look for? The top searched job categories for Remote Utilization Review Rn jobs in Warren, OH are:
What cities near Warren, OH are hiring for Remote Utilization Review Rn jobs? Cities near Warren, OH with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you

Clinical Audit Specialist

On Demand / New Day Recovery LLC

Austintown, OH • On-site, Remote

Other

PTO

Posted 8 days ago

Job description

Recovery Management Services is seeking a detail-oriented and clinically experienced Clinical Audit Specialist to support behavioral health payer audit and denial management, utilization review, and medical necessity appeals for its counseling and residential detox organizations, On Demand Counseling and New Day Recovery.


This role is ideal for a clinician with strong documentation review skills, knowledge of ASAM Criteria, and experience navigating Medicaid, Medicare, MCO, and commercial payer requirements.


Hybrid or remote and flexible scheduling is available for qualified candidates seeking part-time work.

ESSENTIAL FUNCTIONS:

  • Coordinate and manage behavioral health payer audits, denials, and utilization review activities
  • Prepare and submit audit responses, appeals, and supporting clinical documentation
  • Defend medical necessity and level-of-care determinations using ASAM Criteria
  • Conduct peer-to-peer reviews and manage payer appeal processes
  • Monitor audit trends, documentation concerns, and compliance risks
  • Collaborate with clinical, compliance, and revenue cycle teams to improve payer outcomes and audit readiness
  • Provide documentation guidance and education related to medical necessity standards


REQUIRED QUALIFICATIONS:

  • Must be at least 18 years of age.
  • Successful completion of BCI/FBI background check and pre-employment drug screen
  • Active or eligible Ohio clinical licensure preferred, including LPC/LPCC, LSW/LISW, or related behavioral health credentials. Independent licensure preferred.
  • Clinical background with expertise in behavioral health documentation, medical necessity review, ASAM Criteria, and utilization review activities including audits and appeals.

SKILLS AND ABILITIES:

  • Strong clinical reasoning, critical thinking, and decision-making skills.
  • In-depth knowledge of behavioral health documentation standards and medical necessity criteria.
  • Working knowledge of HIPAA and 42 CFR Part 2 as they relate to audits and disclosures.
  • Proficiency with EHR systems and Microsoft Office.
  • Ability to manage multiple priorities and meet strict payer deadlines.
  • Clear, professional written and verbal communication skills.


BENEFITS

  • PTO begins accruing immediately.


EOO/DFWP

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