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Remote Utilization Review Rn Jobs (NOW HIRING)

Personify Health

Lead Utilization Review - RN

$38 - $44/hr

Active RN license * Experience in utilization management, clinical review, or case management ... Familiarity with remote collaboration tools for team visibility and responsiveness Benefits The ...

Personify Health

Lead Utilization Review - RN

$38 - $44/hr

Active RN license * Experience in utilization management, clinical review, or case management ... Familiarity with remote collaboration tools for team visibility and responsiveness Benefits The ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Netsmart

Utilization Review Nurse

Current and unrestricted RN license * At least 3 years clinical experience in acute care setting in ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

McBee Associates

Utilization Review Nurse

Current and unrestricted RN license * At least 3 years clinical experience in acute care setting in ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

Ascension

RN Utilization Review

Southport, FL · On-site +1

$84K - $118K/yr

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

Phoebe Putney Health System

The primary responsibilities of the RN UR Specialist include performing activities related to ... related to Utilization review duties in Care Management. Timely communication of clinical ...

Enterprise Engineering

Be Seen First

Concurrent Utilization Review (UR) Nurse

OR · Remote

$30 - $38/hr

Concurrent Utilization Review (UR) Nurse Remote Opportunity Contract to Hire Must be licenses in ... Registered Nurse (RN) with an active, unrestricted California nursing license required; BSN ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

Utilization Review Nurse Remote Ability to travel on-site to 3031 NE Stephens St., Roseburg OR ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...

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Remote Utilization Review Rn information

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

As of Aug 20, 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 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.

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States with the most job openings for Remote Utilization Review Rn jobs include:

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Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

RN Utilization Review Behavioral Health

Allmed Staffing Inc

Nevada Mass, NV • Remote

$42/hr

Full-time

Medical, Dental, Vision, Retirement

Posted 6 days ago

Job description

RN Utilization Review Behavioral Health

Work Location: Telecommute (Remote) Work Hours: 8:00 AM–5:00 PM PST Pay Rate: $42.00/hour License Preference: Nevada (NV) license preferred Professional Certification Required: Yes Minimum Education Requirement: Master's degree TRICARE-Related Work: No

About the Role

We are seeking a Utilization Review Clinician to review outpatient Applied Behavior Analysis (ABA) requests for medical necessity. This role evaluates provider-submitted treatment plans, progress reports, and assessments against established clinical criteria to support appropriate, timely determinations for behavioral health services.

Key Responsibilities

  • Review outpatient ABA requests for medical necessity using established clinical criteria (e.g., MCG, InterQual, ASAM, plan-specific guidelines)
  • Evaluate treatment plans, progress reports, and assessments submitted by providers
  • Collaborate with providers to clarify documentation and ensure appropriate level of care
  • Make determinations or recommendations for approval, modification, or denial of services
  • Document clinical decisions and rationale in the utilization management system

Required Qualifications

  • BCBA or LBA, RN, or Master's degree in social work or a related behavioral health field (LCSW, LPC, MFT, etc.)
  • Active, unrestricted behavioral health license in the State of Nevada
  • 2+ years of behavioral health clinical experience, including ABA
  • Familiarity with Medicaid and Commercial benefit structures and utilization management protocols
  • Ability to work independently and within a team in a remote or office-based environment
  • Proficient in using clinical systems, Microsoft Office applications, and electronic documentation platforms
  • Proven ability to multi-task in a high-volume, deadline-driven setting

Company Description

Allmed is a National Staffing and Recruiting company offering short and long term staffing solutions.
We have been serving large Fortune 100 companies and providing career opportunities to job seekers for over 25 years. We specialize within the medical and healthcare industries offering temporary and permanent placement options. Our team takes the time to recognize, assess and listen to the goals of both our clients and employees. Our team is dedicated to providing the highest quality services and best qualified medical professionals throughout the United States. We stand by our promise and guarantee success and satisfaction between our clients and employees.