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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

Newton, 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 ...

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 ...

DataAnnotation

Registered Nurse - AI Trainer

Worcester, MA · Remote

$50 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

Lancesoft

Licensed Vocational Nurse-LPN

Woonsocket, RI · On-site +1

$26 - $28.50/hr

Remote Work Type: Remote Est. Pay Range: $26.00/hr. To $28.50/hr. All-inclusive on W2 Position ... Review and process complex prior authorization requests using clinical criteria and supporting ...

DataAnnotation

RN - AI Trainer

Worcester, MA · Remote

$50 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

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 ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Worcester, MA

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 Jul 11, 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 84% Full Time, 13% Part Time, and 3% Contract. Highlights an 40% Physical, 4% Hybrid, and 56% Remote job distribution, with an average salary of $87,755 per year, or $42.2 per hour.
Nurse Case Manager

Nurse Case Manager

VIVA USA INC

Woonsocket, RI • On-site, Remote

Contractor

Re-posted 28 days ago

Job description

Fully remote (never coming onsite)
Description:
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits. Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Duties
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations.
Experience
2-3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
2 years Healthcare and/or managed care industry experience.
Case Management experience required.
Requires an RN with unrestricted COMPACT active license
Education
RN with current unrestricted compact state licensure.
Case Management Certification CCM preferred
Requires an RN with unrestricted active license in Georgia.
REQUIRED:
Must have experience working a remote position previously.
Must have case management experience.
Notes:
Monday- Friday 8am - 5pm EST
Remote
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status

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