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Remote Utilization Review Rn Jobs (NOW HIRING)

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 ...

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 ...

This is a remote position. Essential Functions & Responsibilities: * Identifies the necessity of ... Current Nursing licensure in the state of operation required; RN is required unless local state ...

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ... Current Nursing licensure in the state of operation required; RN is required unless local state ...

Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 ... Utilization Review Certification designation. * Knowledge of CMS Regulations. Working Conditions ...

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Remote Utilization Review Rn information

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$68

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 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.

More about Remote Utilization Review Rn jobs

What cities are hiring for Remote Utilization Review Rn jobs?

Cities with the most Remote Utilization Review Rn job openings:

What are the most commonly searched types of Utilization Review Rn jobs?

The most popular types of Utilization Review Rn jobs are:

What states have the most Remote Utilization Review Rn jobs?

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

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.

Utilization Review Specialist

Cutting Edge Staffing LLC

Pompano Beach, FL • Remote

$50K - $65K/yr

Full-time

Posted 25 days ago


Job description

Utilization Review Specialist | Remote | Full-Time
$50,000 – $65,000 Annually | Weekdays (Weekend Availability as Needed)

Banyan Treatment Centers is seeking an experienced and detail-driven Utilization Review Specialist to join our corporate team. In this remote role, you'll manage a caseload of 50–75 patients, conducting admission and continuing-stay reviews, coordinating authorizations, and serving as a key liaison between Banyan's clinical operations and the managed care organizations that fund patient treatment. Your work directly protects patient access to care and keeps the business running.

This is a high-volume, relationship-driven role for someone who thrives on precision, knows how to navigate managed care, and understands the stakes on both sides of the authorization process.

About Banyan Treatment Centers

Banyan Treatment Centers is a leading national provider of intensive treatment for individuals facing substance use and mental health disorders. Backed by TPG, one of the nation’s largest private equity investors, Banyan is rapidly expanding access to high-quality, compassionate care.

Why Join Our Team?

  • Mission-driven work with real business impact — your authorizations directly determine whether patients stay in treatment. Few roles sit closer to the intersection of clinical care and organizational sustainability.
  • Nationally recognized organization — Joint Commission–accredited, with 18 locations and telehealth services nationwide, and the infrastructure to support your work at scale.
  • Remote flexibility — work from anywhere while collaborating with clinical, billing, and operations teams across the country.
  • Collaborative environment — partner closely with clinical, operational, and billing teams to resolve outstanding case issues, support discharge planning, and ensure timely reimbursement.
  • Room to grow — join a rapidly expanding organization where UR professionals have visibility across the enterprise and opportunities to advance.
  • Comprehensive benefits including medical, dental, and vision insurance; whole and term life insurance; short- and long-term disability; 401(k) with employer match; paid time off and holidays; wellness incentives; and employee assistance and referral programs.

Key Responsibilities

  • Manage a caseload of 50–75 patients, authorizing 15–25 cases daily and ensuring timely utilization reviews and appropriate level of care determinations
  • Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards
  • Verify insurance benefits, coordinate authorizations, and communicate effectively with external case managers and managed care organizations
  • Establish and maintain contracts with managed care companies and request rate increases when appropriate
  • Collaborate with clinical and billing departments to support discharge planning, documentation, and timely reimbursement
  • Identify and address over- and underutilization trends
  • Assist in resolving outstanding case issues with insurers

Qualifications

Required:

  • High school diploma or equivalent
  • Minimum one year of utilization review experience in a psychiatric or chemical dependency setting
  • Strong organizational, documentation, and communication skills
  • Ability to manage high caseloads with accuracy and efficiency
  • Comfortable working independently in a remote environment

Preferred:

  • Graduate degree in a health or behavioral health related field
  • Clinical licensure (LCSW, LMHC, LPC, RN, or equivalent) — valued but not required
  • Experience working with managed care organizations, insurance authorization, and level of care criteria
  • Familiarity with Joint Commission standards and behavioral health regulatory requirements

Apply Now

If you're experienced in utilization review, thrive in a fast-paced and high-volume environment, and want your work to matter beyond the spreadsheet, we'd like to meet you. Apply today to join the Banyan Treatment Centers corporate team.

Banyan Treatment Centers is an equal opportunity employer.