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Remote Utilization Review Rn Jobs in Wyckoff, NJ

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 ...

HURC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

Hurc LLC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

PONOS MGMT INC

New Jersey-RN Case Manager

Jersey City, NJ · Remote

$45 - $60/hr

In this role, the nurse manages a complex caseload of members and provides both remote support and ... Participate in interdisciplinary team meetings and case reviews to align on care strategies and ...

PONOS MGMT INC

New Jersey-RN Case Manager

Union, NJ · Remote

$45 - $60/hr

In this role, the nurse manages a complex caseload of members and provides both remote support and ... Participate in interdisciplinary team meetings and case reviews to align on care strategies and ...

PONOS MGMT INC

New Jersey-RN Case Manager

Jersey City, NJ · Remote

$45 - $60/hr

In this role, the nurse manages a complex caseload of members and provides both remote support and ... Participate in interdisciplinary team meetings and case reviews to align on care strategies and ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Wyckoff, NJ

Remote Utilization Review Rn information

See Wyckoff, NJ salary details

$22

$43

$71

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

As of Aug 23, 2026, the average hourly pay for remote utilization review rn in Wyckoff, NJ is $43.68, according to ZipRecruiter salary data. Most workers in this role earn between $34.52 and $50.14 per hour, depending on experience, location, and employer.

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 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 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 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 cities near Wyckoff, NJ are hiring for Remote Utilization Review Rn jobs?

Cities near Wyckoff, NJ 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 Wyckoff, NJ as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $90,845 per year, or $43.7 per hour.

*REMOTE* Pathologist (Hematopathology) Peer Reviewers

Provider Resources, LLC

New York, NY • Remote

Other

Re-posted 6 days ago

Job description

Provider Resources, LLC (PRI) is seeking board-certified clinicians to join our panel for an important mission of ensuring quality healthcare for our Nation’s Veterans.
As a VA medical reviewer, you will conduct thorough, objective case reviews to assess the quality and appropriateness of care provided to Veterans. This is a remote, flexible position that allows you to contribute your clinical expertise while maintaining your current practice.
What Should I Expect?
  • Performs comprehensive medical record peer reviews for determination of appropriate clinical outcomes in accordance with all State and Federal mandated regulations
  • Make clinical judgments based on clinical experience and evidence-based medical research as a Subject Matter Expert (SME) in your clinical area of expertise
  • Maintain compliance with all regulation changes as they impact medical and utilization review practices
  • Document all review information as instructed
  • Communicate report results to the appropriate supervisor
  • Access electronic health information, as assigned/granted
Do I Qualify?
  • Must hold a current medical license
  • Must be board certified within their clinical specialty (as appropriate)
  • Currently works a minimum of 20 hours per month within their area of clinical specialty
  • Must have a minimum of 5 years full-time experience in direct care
  • Must be actively seeing patients within the last 3 years
Website: https://www.provider-resources.com/vareviews • Email: pripanel@provider-resources.com

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