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Senior Specialist Remote Utilization Review Jobs

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Netsmart

Utilization Review Nurse

Utilization Review Nurse Responsible for utilization review work for emergency admissions and ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

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 ...

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 ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ... For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level ...

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 ...

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Senior Specialist Remote Utilization Review information

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How much do senior specialist remote utilization review jobs pay per year?

As of Aug 15, 2026, the average yearly pay for senior specialist remote utilization review in the United States is $93,575.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,500.00 and $121,000.00 per year, depending on experience, location, and employer.
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Senior Specialist Remote Utilization Review jobs near you
Infographic showing various Senior Specialist Remote Utilization Review job openings in the United States as of August 2026, with employment types broken down into 89% Full Time, 3% Temporary, and 8% Contract. Highlights an 5% In-person, and 95% Remote job distribution, with an average salary of $93,575 per year, or $45 per hour.

Utilization Review Nurse

Oscar Health

Miami, FL • Remote

$35 - $45.94/hr

Full-time

Posted 23 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

257th of 308 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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