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Remote Utilization Review Rn Jobs in Worcester, MA

VIVA USA INC

Nurse Case Manager

Woonsocket, RI · On-site +1

Through the use of clinical tools and information/data review, conducts comprehensive assessments ... RN with unrestricted active license in Georgia. REQUIRED : Must have experience working a remote ...

VIVA USA INC

Nurse Case Manager

Woonsocket, RI · On-site +1

Through the use of clinical tools and information/data review, conducts comprehensive assessments ... RN with unrestricted active license in Georgia. REQUIRED : Must have experience working a remote ...

Varsity Tutors

NCLEX-RN Tutor

Waltham, MA · Remote

$18 - $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 ...

Brown & Brown Insurance

Consultant

Southborough, MA · On-site +1

$100K - $125K/yr

This role offers flexibility with remote or hybrid work options. As a Consultant, you will manage ... Analyze data and financial metrics , conduct utilization reviews, and perform peer audits to ...

UnitedHealth Group

Customer Service Representative

Auburn, MA · Remote

$16 - $21.75/hr

This position is Remote in Auburn, MA. You will have the flexibility to work remotely* as you take ... This includes chart review to identify previous activity that may have occurred related to the call.

Varsity Tutors

NCLEX-PN Tutor

Waltham, MA · Remote

$18 - $40/hr

... RN scope questions, pharmacology calculations, and managing anxiety with the adaptive testing format. Adapts instruction using NCLEX-PN specific practice question banks, content review focused on ...

CareScout

Associate Claims Clinical/Care Advocacy

Waltham, MA · On-site +1

$19.25 - $26.25/hr

Review new product features before they are released to consumers to identify improvements or ... Social worker or RN with 5 years of Geriatric Case management experience. * Ability to demonstrate ...

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Remote Utilization Review Rn information

See Worcester, MA salary details

$21

$42

$68

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

As of Aug 1, 2026, the average hourly pay for remote utilization review rn in Worcester, MA is $42.19, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.46 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 Worcester, MA? For Remote Utilization Review Rn jobs in Worcester, MA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Worcester, MA look for? The top searched job categories for Remote Utilization Review Rn jobs in Worcester, MA are:
What cities near Worcester, MA are hiring for Remote Utilization Review Rn jobs? Cities near Worcester, MA 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 Worcester, MA as of July 2026, with employment types broken down into 67% Full Time, 14% Part Time, and 19% Contract. Highlights an 43% Physical, 3% Hybrid, and 54% Remote job distribution, with an average salary of $87,755 per year, or $42.2 per hour.

Clinical Document Specialist (RN), REMOTE, 40hrs

UMass Memorial Health

Worcester, MA • On-site, Remote

$34.75 - $46.75/hr

Full-time

Posted 10 days ago

UMass Memorial Health rating

7.5

Company rating: 7.5 out of 10

Based on 154 frontline employees who took The Breakroom Quiz

231st of 887 rated healthcare providers

Job description

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account.
Exemption Status:
Exempt
Hiring Range:
$91,644.80 - $164,944.00
Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations.
Schedule Details:
Monday through Friday
Scheduled Hours:
40 hrs
Shift:
1 - Day Shift, 8 Hours (United States of America)
Hours:
40
Cost Center:
99940 - 5401 Clinical Documents Specialists
This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.
Everyone Is a Caregiver
At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.
Drawing upon clinical knowledge and experience, closely collaborates with physicians and other team members to ensure that patient records accurately document the status, complexity and intensity of patient conditions and care.
Drawing upon clinical knowledge and experience, closely collaborates with physicians and other team members to ensure that patient records accurately document the status, complexity and intensity of patient conditions and care.
Major Responsibilities:
  • Works collaboratively with physicians, nurses, and other staff to ensure accurate and complete medical record documentation to appropriately reflect severity of illness and risk of mortality.
  • Reviews inpatient medical records for identified payer populations or clinical specialties upon admission and throughout hospitalization. Analyzes clinical status of patient, current treatment plan and past medical history and identifies potential gaps in physician documentation.
  • Communicates with attending physicians either verbally or electronically to validate observations and suggest additional and/or more specific documentation.
  • Supports Physician leaders with focused documentation reviews and special projects as directed.
  • Supports appropriate documentation for coding, reimbursement and quality purposes.

Position Qualifications:
License/Certification/Education:
Required:
  • Massachusetts licensure as a registered nurse required

Preferred:
  • Bachelor's degree preferred

Experience/Skills:
Required:
  • Experience in direct patient care, case management, utilization review or equivalent required.
  • Knowledge of clinical documentation practices and principles and ICD-10-CM diagnosis codes required.
  • Excellent interpersonal skills and demonstrated ability to interact with physicians in a collaborative and professional manner.
  • Ability to effectively use specialized computer based systems for gathering, reporting, and analyzing critical data.

Preferred:
  • 1-3 years of CDI experience preferred

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.
As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.
If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.

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