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Remote Utilization Review Rn Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. * 3 ...

CommonSpirit Health

California RN license. * AHA BLS * Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. * Proficient in application of clinical guidelines (MCG/InterQual ...

Village Care

Utilization Review Nurse

Manhattan, NY · Remote

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - NY, NJ, or CT COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is ...

Ascension

RN Utilization Review

Austin, TX · Remote

$84.06K/yr

Remote Facility: Ascension Network Services Department: Utilization Management Schedule: Full Time ... Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state ...

Ascension

RN Utilization Review

Austin, TX · Remote

$84.06K - $118.67K/yr

Remote Facility: Ascension Network Services Department: Utilization Management Schedule: Full Time ... Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state ...

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

As of May 29, 2026, the average hourly pay for remote utilization review rn in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.

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What are the most commonly searched types of Utilization Review Rn jobs? The most popular types of Utilization Review Rn jobs are:
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Remote Utilization Review Rn jobs near you

Registered Nurse - Utilization Review - RNUR26-06087

NavitasPartners

San Jose, CA • Remote

$40/hr

Full-time

Posted 3 days ago

Job description

Job Title: Registered Nurse – Utilization Review

Location: Santa Rosa, CA

Shift Details: Day Shift | 5x8 Hours | 08:00 AM – 04:30 PM
Contract Duration: 13 Weeks
Orientation: 40 Hours (Non-Billable)

Required Qualifications
  • Active Registered Nurse (RN) License required
  • Minimum 1–2 years acute care nursing experience preferred
  • Experience in Utilization Review, Case Management, or similar role preferred
  • Strong understanding of medical necessity, payer guidelines, and clinical documentation
  • Knowledge of insurance authorization processes preferred
  • Strong analytical, communication, and decision-making skills
  • Ability to work independently in a remote environment
  • Proficiency with EMR systems preferred (Epic experience a plus)
Job Responsibilities
  • Perform utilization review of inpatient and outpatient cases
  • Evaluate medical necessity based on clinical guidelines and payer policies
  • Review patient records and documentation for appropriate level of care
  • Collaborate with physicians, case managers, and insurance providers
  • Process prior authorizations and continued stay reviews
  • Document all review decisions accurately in EMR systems
  • Identify cases requiring further clinical escalation
  • Ensure compliance with regulatory, hospital, and insurance standards
  • Support discharge planning and care coordination as needed
  • Maintain productivity and quality standards in a remote setting

For more details contact at sthakur@navitashealth.com

About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.