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Remote Utilization Review Jobs (NOW HIRING)

UK St Claire

Utilization Review Nurse

Morehead, KY · On-site +1

Supports utilization review processes by planning, analyzing data, and setting goals to ensure appropriate reimbursement and adherence to guidelines. Essential Functions • Abstracts and assembles ...

Enterprise Engineering

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Concurrent Utilization Review (UR) Nurse

OR · Remote

$30 - $38/hr

Concurrent Utilization Review (UR) Nurse Remote Opportunity Contract to Hire Must be licenses in California The Concurrent Utilization Review (UR) Nurse is responsible for conducting real-time ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ...

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Remote Utilization Review information

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How much do remote utilization review jobs pay per hour?

As of Jun 26, 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 the Remote Utilization Review position, and why are they important?

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 typical day look like for someone in a Remote Utilization Review role?

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 job?

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 June 2026, with employment types broken down into 84% Full Time, 3% Part Time, and 13% Contract. Highlights an 2% In-person, and 98% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review- RN

Utilization Review- RN

Oregon Health & Science University

Remote

$55.24 - $92.02/hr

Part-time

Medical, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Oregon Health & Science University rating

8.1

Company rating: 8.1 out of 10

Based on 93 frontline employees who took The Breakroom Quiz

131st of 539 rated colleges and universities

Job description

Department Overview
The Utilization Management Department enacts the hospital UR Plan. The department provides for the assessment of the medical necessity of admission and continued stay, appropriate bed status, denials management, and outlier review. The department provides clinical information to third party payers to assure medical necessity requirements are met to secure authorization.
This position also comes with great benefits! Some highlights include:
  • Comprehensive health care plans. Covered at 100% of the cost for full-time employees and 88% for dependents.
  • $50K of term life insurance provided at no cost to the employee
  • Two separate above market pension plans to choose from
  • Vacation - 192 to 288 hours per year depending on length of service, prorated for part-time
  • Holidays - up to 64 holiday hours per calendar year (employees accrue .0308 holiday hours for each hour paid - included in vacation accruals)
  • Sick Leave - 96 hours per year, prorated for part-time
  • Substantial public transportation discounts (Tri-met and C-Tran)
  • Tuition Reimbursement
  • Innovative Employee Assistance Program (EAP) including extensive wellness resources

Function/Duties of Position
Utilization Management Nurses work within the multidisciplinary team to determine medical necessity of admission and continued stay in the hospital as well as correct patient classification and efficient use of resources. They conduct robust utilization review. Utilization Management Nurses use established criteria to determine appropriateness of admission and continued stay and work with payers to assure ongoing authorization for continued stay. They contribute to meeting OHSU's strategic plan of safe LOS reduction and reduction in readmission rates.
Specifically, the UM Nurse does the following:
  • Reviews pre-admissions for correct classification and admission order.
  • Performs Utilization Review for each patient on their assigned daily census using established medical necessity guidelines.
  • Communicates with payers regarding authorization and medical necessity, utilizing excellent negotiating skills.
  • Reviews order/classification discrepancies and take actions to resolve the discrepancy.
  • Discusses cases with providers and Case Managers as needed, including attending physicians and escalation to the Care Management Physician Advisor when indicated.
  • Assesses for and tracks potentially avoidable hospital days.
  • Assesses for and records reasons for readmissions.
  • Participates in and supports strategic initiatives to reduce readmissions and LOS.
  • Attends and contributes to Outlier Review rounds on ad hoc basis.
  • Provides education regarding Utilization Management issues to the Multidisciplinary team.
  • Prepares and conducts presentations, as assigned, to their assigned physician groups regarding issues related to Utilization Management in conjunction with the Care Management Physician Advisor.
  • Educates providers regarding documentation requirements that support medical necessity determinations.
  • Prepares and presents reports as requested by UM Management.
  • Facilitates MD Advisor to payer discussions.
  • Assesses whether there is a basis for written appeal for cases in which payment is denied due to medical necessity concerns. Seek input from attending physicians and physician advisor as needed.
  • Composes persuasive and grammatically correct written appeals for claims denied by payers for lack of medical necessity whether denied pre or post payment. This may include denials through retrospective audits by payers or through government audits.
  • Presents Case Studies illustrating systems issues that adversely affect LOS and/or readmission rates to the Clinical Resource Management Committee and the Care Management Department.
  • Serves as member of department and/or hospital committees and task forces working on issues related to Utilization Management, as assigned.
  • Delivers Condition Code 44 notices, Observation notices (MOON), and Medicare Important Messages (IMM) in the absence of sufficient clerical support.
  • Educates patients about their classification and financial implications as needed.
  • Communicates in writing with attending physicians about UR Committee cases.
  • Facilitates Utilization Review case reviews in accordance with Medicare Conditions of Participation: Utilization Review.
  • Coordinates and processes Medicare discharge appeals along with clerical support.
  • Conducts secondary reviews for peers, assessing appropriate classification and medical necessity.
  • Communicates closely with the multidisciplinary team about patients' expected hospital course, expected discharge date, GMLOS, and authorization status.
  • Communicates status upgrades and downgrades with the Bed Flow Manager.
  • Documents according to departmental policy.
  • Works with coding, patient business services, surgery schedulers, registration, and c integrity department to determine correct billing and coding status for complex cases and assure correct classification.
  • Provides feedback to managed care contracting regarding insurance company billing policies and practices that adversely affect OHSU's ability to collect proper reimbursement for care provided.
  • Leads the effort to assure compliance with CMS and other insurance regulations related to Utilization Review.
  • Maintains current knowledge of, and complies with regulatory requirements of DNV, Medicaid, Medicare, CMS, applicable state regulations and Oregon Nurse Practice Act.
  • Other UM activities as assigned

Department Specific Working Conditions:
Utilization Management follows patients on every inpatient, observation, and overnight day stay unit and the Emergency department. Some work occurs in support of procedural areas as well.
Each Utilization Management Nurse has access to a computer workstation as this is a teleworking position. There is heavy frequent use of computers and telephones.
Proficiency in use of Microsoft Office
    • Word: create documents or outlines that may include use of tables, bullets, headers, footers, and basic formatting
    • Excel: ability to create and use basic spreadsheets that do not involve formulas or pivot tables.
    • PowerPoint: ability to create basic presentations in outline form using approved OHSU graphics
  • Proficient at creating formal presentations and presenting to groups of medical professionals
  • Demonstrated proficiency with conflict resolution
  • Demonstrated proficiency working cooperatively and productively to achieve shared goals as a member of a team.
  • Excellent written communication skills, including demonstrated ability to compose persuasive and grammatically correct written arguments
  • Excellent verbal communication skills
  • Successful experience in a leadership role in the past 10 years (eg: charge nurse, nurse manager, UBNPC chair, group facilitator, hospital-wide committee membership, etc.)
  • Proficiency within the interdiscipinary team in resolving conflicts, communicating and educating physicians on patient status decisions and other issues related to Utilization Management.
  • Proficient in use of Interqual or MCG criteria.
  • Understanding of the CMS rules and regulations.
  • Ability and willingness to do presentations to groups of physicians and hospital leadership.
  • Demonstrated ability to work independently with a minimum of supervision while meeting performance targets.

Required Qualifications
  • Three years of UM/UR experience required
  • BSN Graduates: Baccalaureate Degree in Nursing from a program accredited by Commission of Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN) or Commission for Nursing Education Accreditation (CNEA) 30 days before start date.
  • ADN Graduates: Associate Degree in Nursing from an accredited program 30 days before the start date.
  • Associate degree Nurses required to enroll in BSN program within 3 years of hire and complete within 5 years of hire
  • Current, unencumbered Oregon State Registered Nurse License
  • BLS from AHA required. New hires will be enrolled and required to complete during orientation.
  • Must be able to perform the essential functions of the position with or without accommodation

Preferred Qualifications
  • Case Management Certification (ACM-RN, RN-BC, CCM, CGS, etc) preferred
  • Knowledge of MCG, Indicia guidelines preferred

Additional Details
Length of Orientation - Experienced Nurse
  • External candidates: OHSU & Nursing New Employee Orientation (NEO) for about a week.
  • Either Transition to Practice (TTP) Program Specialty Fellowship/Fellowship Learning Pathway or Orientation experience for 3 days-26 weeks depending on the care area. An employment service agreement may apply.

Why apply to OHSU?
We are Oregon's only public academic health center.
In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.
All are welcome.
OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply.
To request reasonable accommodation, contact askhr@ohsu.edu

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About Oregon Health & Science University

Sourced by ZipRecruiter

Oregon Health & Science University (OHSU) is a distinguished institution under the industry of higher education and healthcare, specifically in the field of medical science. Based in Portland, Oregon, US, it maintains a reputation for promoting research, teaching, patient care, and outreach. Established in 1887, OHSU has continually sought to redefine the parameters of healthcare delivery and biomedical discovery through its expansive catalog of programs and initiatives. A galvanizing mission drives OHSU: to improve the health and quality of life for all Oregonians through excellence, innovation, and leadership in health care, education, and research.

Industry

Colleges, universities, and professional schools

Company size

10,000+ Employees

Headquarters location

Portland, OR, US

Year founded

1887

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