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Remote Utilization Review Rn Jobs in York, PA (NOW HIRING)

Varsity Tutors

NCLEX-RN Tutor

Harrisburg, PA · Remote

$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 ...

Urrly

Telehealth Nurse Practitioner (Remote)

Harrisburg, PA · Remote

$600 - $720/hr

Role: Telehealth Nurse Practitioner * Location/Type: Pennsylvania Remote (No travel) * Pay: $600 ... Review patient history, medications, and preventive needs * Deliver clear care plans and follow-up ...

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All JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in York, PA

Remote Utilization Review Rn information

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$41

$67

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

As of Jun 13, 2026, the average hourly pay for remote utilization review rn in York, PA is $41.61, according to ZipRecruiter salary data. Most workers in this role earn between $32.88 and $47.79 per hour, depending on experience, location, and employer.

What is the meaning of the word remote?

In the context of a Remote Utilization Review RN job, 'remote' refers to working outside of a traditional office setting, often from home or another location of the employee's choice. This setup typically involves using digital tools and communication platforms to perform job duties without being physically present in an office environment.

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 meaning of remote in one word?

In the context of a Remote Utilization Review RN role, 'remote' means working from a location outside of a traditional office, typically from home, using digital communication tools. It emphasizes flexibility and virtual access to work systems without physical presence at a healthcare facility.

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.

How to make 2000 a week working from home?

A Remote Utilization Review RN can potentially earn $2,000 weekly by working full-time hours, often 40 hours per week, and gaining experience or certifications that allow for higher billing rates. Increasing income may involve taking on additional cases, specializing in high-demand areas, or working for agencies that offer competitive pay for remote utilization review roles.

What is remote job?

A remote Utilization Review RN job is a healthcare position where the nurse reviews patient cases and insurance claims from a location outside of a traditional office, often working from home. It requires strong communication skills, knowledge of medical documentation, and familiarity with electronic health record systems, with flexible schedules common in remote roles.

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 York, PA? For Remote Utilization Review Rn jobs in York, PA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in York, PA look for? The top searched job categories for Remote Utilization Review Rn jobs in York, PA are:
What cities near York, PA are hiring for Remote Utilization Review Rn jobs? Cities near York, PA with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you

Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance- Med Surg ...

The CKHobbie Group

Harrisburg, PA • On-site, Remote

$40 - $42/hr

Full-time

PTO

Posted 5 days ago

Job description

Job Description
Are you a registered nurse ready to take your career in an exciting newdirection-one where your expertise truly makes a difference? JoinPennsylvania's premier Quality Improvement Organization and step into adynamic role focused on advocacy and program integrity through compliance management. Here, you'll champion the needs of vulnerable populations,safeguard the quality of care, and influence healthcare outcomes on ameaningful scale. Enjoy the freedom of working from home, theflexibility and autonomy to manage your workday, and the opportunity forcontinuous professional growth-all while being part of a passionate,mission-driven team dedicated to improving healthcare across theCommonwealth.
Are you a registered nurse ready to take your career in an excitingnew direction-one where your expertise creates real, lasting impact?Join Pennsylvania's premier Quality Improvement Organization and play a vital role in protecting healthcare quality, advocating forvulnerable populations, and ensuring the integrity of criticalhealthcare programs.
In this rewarding role, you'll use your clinical knowledge outside ofthe traditional bedside setting to review and audit claims, supportprogram integrity initiatives, and advocate for beneficiaries across theCommonwealth. You'll enjoy the flexibility of working from home, theautonomy to manage your work, and meaningful opportunities forprofessional growth-all while contributing to a mission that trulymatters.
What You'll Do
  • Conduct clinical reviews and ensure quality, appropriateness, and compliance with healthcare standards
  • Support program integrity efforts by identifying trends, risks, and opportunities for improvement
  • Advocate for beneficiaries, with a strong focus on protecting and improving care for vulnerable populations
  • Apply nursing judgment to analyze medical records, documentation, and billing data
  • Collaborate with interdisciplinary teams, providers, and stakeholders to promote best practices
  • Contribute to quality improvement initiatives that strengthen healthcare delivery across Pennsylvania

What We're Looking For
  • Active, unrestricted Registered Nurse (RN) license
  • Strong clinical background with the ability to apply nursing judgment analytically
  • Interest in advocacy, quality improvement, and healthcare program integrity
  • Excellent written and verbal communication skills
  • Ability to work independently while managing multiple priorities
  • Comfort with technology and electronic medical records

Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required.
Why Join Us
  • Mission-driven work with Pennsylvania's leading Quality Improvement Organization
  • Make a real impact on healthcare quality and outcomes for vulnerable populations
  • Remote work - enjoy the convenience and balance of working from home
  • Autonomy and flexibility in how you manage your workday
  • Advocacy-focused role that values your nursing voice and expertise
  • Career development opportunities to grow beyond traditional nursing roles
  • Supportive, collaborative team culture committed to excellence and integrity

If you're a registered nurse seeking purpose-driven work,professional growth, and the flexibility to balance your life andcareer-this is your opportunity. Apply today and help shape the future of healthcare quality in Pennsylvania.
Requirements
Be available as a full-time consultant, approximately 37.5 hours per week;
• Possess a current license to practice as a Registered Nurse issued by the Pennsylvania
State Board of Nursing; or possess a non-renewable temporary practice permit issued
by the Pennsylvania State Board of Nursing. Resources possessing non-renewable
temporary practice permits must obtain licensing as a Registered Nurse within the
one-year period as defined by the Pennsylvania State Board of Nursing;
• Possess a documented work history of three (3) or more years of professional
experience with medical assistance, health care services or human services or any
equivalent combination of experience and training;
• Possess basic computer skills, including familiarity with Microsoft Office programs.
Principal Duties and Responsibilities (RN - Medical Assistance Inpatient Utilization Review & Discharge Planning)
  • Conduct clinical utilization reviews for medical-surgical inpatient hospitalizations under the Medical Assistance (MA) Program by evaluating medical records, admission criteria, continued stay indicators, and treatment plans to determine medical necessity, appropriateness, and level of care.
  • Apply registered nursing clinical judgment and evidence-based medical-surgical standards to ensure MA beneficiaries receive safe, effective, and timely inpatient care consistent with MA coverage requirements and regulatory guidelines.
  • Perform prospective, concurrent, and retrospective reviews of inpatient admissions to assess appropriate level of care (e.g., inpatient vs. observation), length of stay, and readiness for discharge.
  • Evaluate discharge planning documentation to ensure timely, safe, and effective transitions of care, including coordination of post-acute services such as home health, durable medical equipment (DME), skilled nursing facility (SNF), rehabilitation, behavioral health follow-up, and community-based supports.
  • Assess provider documentation and hospital billing to ensure compliance with MA policies, inpatient reimbursement rules, and discharge planning requirements, and identify potential fraud, waste, or abuse.
  • Review clinical documentation submitted through electronic medical records, provider portals, telephone communications, fax, and U.S. mail to support utilization and discharge determinations.
  • Make authorization determinations within RN scope of practice by approving, modifying, or denying inpatient stays and post-acute services, or referring cases to physician advisors when medical necessity, level of care, or discharge disposition is unclear.
  • Collaborate with physician/medical consultants and hospital care teams to support peer-to-peer discussions regarding continued stay criteria, discharge readiness, and appropriate post-discharge level of care.
  • Document utilization review findings, clinical rationale, and discharge planning decisions in electronic systems, generating authorization notifications, denial letters, reason codes, and appeal information in compliance with MA regulations.
  • Conduct re-reviews and reconsiderations of inpatient and post-acute service decisions upon request by hospitals, providers, or facilities, in collaboration with physician/medical consultants as needed.
  • Review and prepare appeal cases related to inpatient admissions, continued stays, and discharge determinations by analyzing medical records, preparing case summaries and exhibits, and providing testimony at administrative hearings using knowledge of MA regulations and appeal procedures.
  • Interpret MA inpatient and discharge planning policies, regulations, and utilization management guidelines for hospital staff, providers, and internal stakeholders through consultation, education, and meetings.
  • Participate in interdisciplinary collaboration with hospitals, post-acute providers, medical consultants, social services, legal staff, and program leadership to support patient-centered, compliant, and efficient transitions of care.
  • Maintain professional competence through continuing education and review of current medical-surgical and care transition literature to remain current with standards of care, utilization review best practices, and regulatory changes.
  • Provide cross-coverage in other MA program areas as needed, maintaining working knowledge through training and updates to support continuity of program operations.
  • Respond to inquiries and correspondence from beneficiaries, providers, legislators, legal offices, and external agencies to explain inpatient coverage decisions, discharge planning requirements, and administrative processes.
  • Maintain accurate case documentation and records in accordance with MA regulations, accreditation standards, and organizational policies.
  • Perform related duties and special projects as assigned, with expectations and performance standards communicated at the time of assignment.
  • When required, work at Department-designated locations. The primary work location is Harrisburg, PA, where appropriate workspace, technology, and resources will be provided to support assigned responsibilities.

Benefits
Attractive Compensation plan.Holiday and Vacation program.

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