ZipRecruiter

Log In

2

Remote Utilization Review Jobs (NOW HIRING)

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Prime Healthcare

Utilization Review Technician III

Ontario, CA · On-site +1

$24.65 - $30.03/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Review Nurse Remote Ability to travel on-site to 3031 NE Stephens St., Roseburg OR, 97457, as needed for business operations. Employment Type: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

University of Utah

Utilization Review Nurse

Applies approved utilization criteria to monitor appropriateness of admissions with associated levels of care and continued stay review. * Communication to third-party payers for initial and ...

previous pagenext page

Showing results 21-40

All JobsUtilization Review JobsRemote Utilization Review Jobs

Remote Utilization Review information

See salary details

$21

$42

$68

How much do remote utilization review jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for remote utilization review 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 in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What is a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

More about Remote Utilization Review jobs

What cities are hiring for Remote Utilization Review jobs?

Cities with the most Remote Utilization Review job openings:

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

The most popular types of Utilization Review jobs are:

What states have the most Remote Utilization Review jobs?

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

What job categories do people searching Remote Utilization Review jobs look for?

The top searched job categories for Remote Utilization Review jobs are:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in the United States as of August 2026, with employment types broken down into 94% Full Time, and 6% Part Time. Highlights an 6% In-person, and 94% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Netsmart Technologies, Inc.

Remote

Full-time

Posted 6 days ago

Netsmart rating

8.3

Company rating: 8.3 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

44th of 224 rated it services

Job description

Responsible for utilization review work for emergency admissions and continued stay reviews
Responsibilities
  • Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria
  • Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources
  • Participate in telephonic discussions with emergency department physicians relative to documentation and admission status
  • Enter clinical review information into system for transmission to insurance companies for authorization
  • Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources

Qualifications
Required
  • Current and unrestricted RN license
  • At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
  • At least 2 years utilization management experience in acute admission and concurrent reviews
  • Intermediate level experience with InterQual and/or MCG criteria within the last two years
  • Proficiency in medical record review in an electronic medical record (EMR)
  • Experience in Microsoft Suite including Office and basic Excel
  • Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs
  • Passing score(s) on job-related pre-employment assessment(s)

Preferred
  • At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
  • At least 3 years utilization management experience within the hospital setting
  • Bachelor's of Science in Nursing (BSN)
  • Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC)

Expectations
  • Comfortable with remote work arrangements and virtual collaboration tools
  • Physical demands include extended periods of sitting, computer use, and telephone communication

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.
Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider.
If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled.
All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.
Netsmart's Job Applicant Privacy Notice may be found here.

What Netsmart employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply