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Remote Utilization Review Social Worker Jobs (NOW HIRING)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Working with a variety of personalities, maintaining a consistent and fair communication style.

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Working with a variety of personalities, maintaining a consistent and fair communication style.

VIVA USA INC

Utilization Review Nurse

Albuquerque, NM · On-site +1

Position Overview Remote position in any state except, NY, CA, HI, or AK Summary This Position Is ... Communicate and interact effectively and professionally with co-workers, management, customers, etc ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ... Knowledge of the workers' compensation claims process preferred * Knowledge of outpatient ...

UK St Claire

Utilization Review Nurse

Morehead, KY · On-site +1

We strive to foster the talent and potential of our employees and prioritize safe working ... Supports utilization review processes by planning, analyzing data, and setting goals to ensure ...

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How much do remote utilization review social worker jobs pay per hour?

As of Jun 17, 2026, the average hourly pay for remote utilization review social worker 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 Social Worker, and why are they important?

To thrive as a Remote Utilization Review Social Worker, you need a background in social work (often a MSW and relevant licensure), knowledge of medical terminology, and experience in patient care coordination. Familiarity with utilization management software, electronic health records (EHRs), and certification such as ACM or CCM is typically required. Strong analytical thinking, communication skills, and the ability to work independently are vital soft skills for this position. These skills ensure effective patient advocacy, compliance with regulations, and optimal resource utilization in a remote healthcare environment.

How does a Remote Utilization Review Social Worker typically collaborate with interdisciplinary teams while working off-site?

Remote Utilization Review Social Workers regularly communicate with physicians, nurses, case managers, and insurance representatives through virtual meetings, secure emails, and electronic health record systems. Despite working remotely, they play a key role in ensuring appropriate patient care by reviewing cases, discussing treatment plans, and advocating for necessary services. Collaboration often involves scheduled case conferences and prompt responses to queries, requiring strong organizational and digital communication skills. Building effective working relationships remotely is crucial for delivering coordinated, patient-centered care.

What does a Remote Utilization Review Social Worker do?

A Remote Utilization Review Social Worker evaluates patient care plans and medical records to ensure that healthcare services are medically necessary, appropriate, and cost-effective. Working remotely, they collaborate with healthcare providers, insurance companies, and patients to review treatment plans and make recommendations on care approvals or alternatives. Their goal is to help manage healthcare costs while ensuring patients receive the care they need, often working within hospitals, insurance companies, or third-party review organizations.
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Remote Utilization Review Social Worker jobs near you
Utilization Review Nurse

Utilization Review Nurse

Rising Medical Solutions

Chicago, IL • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Rising Medical Solutions has an opening for a Utilization Review Nurse, and we want to hear from you! We're a bill review and cost containment company - so what does that mean? Basically we are trying to fix a very broken healthcare system by reducing the cost of healthcare claims through bill review, case management, and utilization review. Our mission is "To make lives better" and everyone here at Rising works hard to achieve this goal. So take a look at the job, let us know what you think, and let's start working towards a better future!
**This is a full-time position - 40 hours per week (Must work M-F each day).
Responsibilities
  • Perform all aspects of the Utilization Review Process
  • Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone
  • Utilize evidence-based guidelines to determine if authorization can be given versus having to send the file or for Peer or Physician Review
  • Write nurse summaries on all UR files
  • Document properly in Rising's database (and client data bases when appropriate), and send determination letters on each completed UR
  • Establish collaborative relationships with clients, patients, employers, providers and attorneys
  • Track ongoing status of all UR activity so that appropriate turn-around times are met
  • Maintain organized files containing clinical documentation of interactions with all parties of every claim
  • Utilize good clinical judgment, careful listening, and critical thinking and assessment skills
  • Respond to various written and telephonic inquiries regarding status of case
  • Must be proficient in the use of a computer, including the use of various software programs simultaneously

Requirements
  • An Associate's or Bachelor's degree in Nursing
  • Hold an active and unencumbered RN license in one or more states
  • 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience
  • More than one state license (a plus)
  • Experience with Workers' Compensation, short-term or long-term disability, or liability claims
  • The ability to set priorities and work both autonomously and as a team member
  • Well-developed time-management, organization, and prioritization skills
  • Excellent analytical skills
  • Superb oral and written communication
  • The ability to gather data, compile information, and prepare summary reports
  • Strong interpersonal and conflict resolution skills
  • Experience in a fast-paced, multi-faceted environment
  • Demonstrated persistence and attention to detail
  • General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines
  • Working knowledge of: Microsoft Word, Excel, and Outlook
  • Ability to remain calm during stressful situations
  • A customer-service mindset

Benefits
    • Generous Flexible Time Off (take it when you need it!)
    • Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matching
    • Career Growth Opportunities - We often promote from within
    • Professional Development Reimbursement Program (PDRP)
    • You will be part of our new Elevate program designed to recognize and reward employees for their hard work
    • Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Working at Rising Medical Solutions Top Workplaces
    • We're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical
    • Want to see more? Check out our:
      • Facebook: https://www.facebook.com/RisingMedicalSolutions
      • LinkedIn: http://www.linkedin.com/company/rising-medical-sol..

If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!

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