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Telecommute Nicu Utilization Review Jobs (NOW HIRING)

NICU

NICU- Clinical Nurse Specialist

Riverside, CA · On-site

Clinical Nurse Specialist The Clinical Nurse Specialist shall be responsible for directing the clinical nursing practice in the NICU & Pediatric Unit. Coordination and assessment of educational ...

St. David's HealthCare

Neonatal ICU (NICU)

Austin, TX · On-site

Neonatal Icu (nicu) Rn Travel Job Genie Healthcare is looking for a RN to work in Neonatal ICU (NICU) for a 13 weeks travel assignment located in Austin, TX for the Shift (3x12 nights, 19:00:00-07:00 ...

ICONMA

RN - Neonatal ICU - NICU

Brighton, MA · On-site

RN - Neonatal ICU - NICU Our Client, a Medical Center company, is looking for a RN - Neonatal ICU - NICU for their Brighton, MA location. Responsibilities: * The Registered Nurse in the NICU provides ...

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How much do telecommute nicu utilization review jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for telecommute nicu 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 is a telecommute NICU utilization review?

Telecommute NICU Utilization Review jobs involve remotely evaluating medical records and care provided to newborns in Neonatal Intensive Care Units (NICUs) to ensure treatments are medically necessary and comply with insurance guidelines. Professionals in these roles review clinical data, coordinate with healthcare providers, and make recommendations regarding coverage decisions. They typically work for insurance companies, healthcare organizations, or third-party administrators, leveraging their clinical expertise in neonatology or pediatrics. These jobs require strong analytical skills, attention to detail, and knowledge of medical policies and regulations.

What skills and qualifications are needed for a telecommute NICU utilization review?

To thrive as a Telecommute NICU Utilization Review Nurse, you need a strong background in neonatal intensive care, nursing licensure (RN), and experience with utilization review or case management. Familiarity with electronic medical records (EMRs), utilization management software, and certifications such as CCM (Certified Case Manager) or URAC are commonly required. Excellent communication, attention to detail, and critical thinking are vital soft skills for remote collaboration and accurate assessments. These skills ensure proper care coordination, compliance with guidelines, and effective decision-making in a virtual healthcare environment.

How does a telecommute NICU utilization review professional collaborate with on-site clinical teams while working remotely?

As a Telecommute NICU Utilization Review professional, you regularly interact with on-site clinical teams through secure digital communication tools, such as video conferences, phone calls, and electronic health record systems. Effective collaboration involves discussing patient cases, clarifying documentation, and ensuring that care decisions align with established guidelines. Building strong communication skills and maintaining organized records are crucial, as you often act as a liaison between remote review processes and the NICU staff. This collaborative approach helps ensure quality patient care while supporting efficient utilization of resources.

What is the difference between Telecommute Nicu Utilization Review vs Telecommute Pediatric Utilization Review?

AspectTelecommute Nicu Utilization ReviewTelecommute Pediatric Utilization Review
Required CredentialsRN license, utilization review certificationRN license, utilization review certification
Work EnvironmentRemote, healthcare insurance companiesRemote, healthcare insurance companies
Industry UsageCommon in neonatal care reviewsCommon in pediatric care reviews

Both roles involve remote review of medical cases, requiring nursing credentials and utilization review certification. The main difference lies in the patient population: NICU reviews focus on neonatal cases, while pediatric reviews cover broader pediatric cases. Understanding these distinctions helps candidates choose the role that best matches their expertise and interests.

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Telecommute Nicu Utilization Review jobs near you
Infographic showing various Telecommute Nicu Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

NICU Utilization Management Nurse Consultant - Louisiana Residence Preferred

CVS Health

Remote

$26.01 - $56.14/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 5 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,359 frontline employees who took The Breakroom Quiz

92nd of 113 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

NICU Utilization Management Nurse Consultant (Remote)

Are you passionate about improving outcomes for the most vulnerable patients? We are seeking an experienced NICU Utilization Management Nurse Consultant to support high-risk neonatal populations through clinical review, care coordination, and evidence-based decision-making.

In this role, you will collaborate with neonatologists, hospitals, case managers, and interdisciplinary teams to evaluate medical necessity, determine appropriate levels of care, and facilitate timely, cost-effective services for newborns and infants requiring specialized care. You'll play a critical role in supporting quality outcomes, discharge planning, and seamless transitions of care while ensuring compliance with regulatory and accreditation standards.

What You'll Bring - REQUIRED

  • Active, unrestricted RN license in the state of residence. Ability to obtain and maintain additional state licensure as required by business needs.
  • 3+ years of clinical NICU nursing experience minimum
  • 1+ years of experience in utilization management, case management, managed care, NICU, pediatrics, or maternal-child health
  • Strong knowledge of neonatal intensive care, prematurity, congenital conditions, and complex infant care needs
  • Experience reviewing medical records and applying evidence-based clinical criteria (MCG or similar tools)
  • Excellent clinical judgment, communication, and collaboration skills
  • Proficiency with electronic medical records and utilization management systems
  • Associates Degree in Nursing

Preferred Qualifications

  • BSN
  • NICU, pediatric inpatient, maternal-child health, or neonatal case management experience
  • Health plan utilization management experience (Medicaid, Medicare, or Commercial)
  • Experience supporting Louisiana Medicaid populations
  • Louisiana residency preferred

Why Join Us?

  • Meaningful work that directly impacts neonatal and infant health outcomes
  • Collaborative, mission-driven environment
  • Opportunity to leverage your NICU expertise in a remote setting
  • Focus on quality, innovation, and member-centered care

If you're a skilled RN with a passion for neonatal care and utilization management, we'd love to hear from you. Apply today to help ensure the right care is delivered at the right time for our smallest patients.

Work from Home Requirements:

  • You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
  • A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
  • Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
  • The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
  • If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

  • Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
  • Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
  • Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
  • Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
  • Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
  • Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 09/12/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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