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Utilization Review Specialist Remote Jobs (NOW HIRING)

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote (U.S.) -- Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension ...

Nexus Health Systems

Remote UTILIZATION REVIEW NURSE - RN

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Remote Utilization Review Registered Nurse (UR RN) Location: Remote (Texas RN License or Compact License Required) Company: Nexus Health Systems Employment Type: Full-Time Make an Impact from ...

New

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 ...

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Utilization Review Specialist Remote information

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How much do utilization review specialist remote jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for utilization review specialist remote in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What is a utilization review specialist?

Utilization Review Specialists (Remote) are healthcare professionals who work from home to evaluate the necessity, appropriateness, and efficiency of medical treatments and services. They review patient records, medical documentation, and insurance information to ensure healthcare services meet established guidelines and regulations. Their goal is to help manage healthcare costs while ensuring patients receive appropriate care, often acting as a liaison between healthcare providers, insurance companies, and patients.

What are the key skills and qualifications needed to thrive as a utilization review specialist?

To thrive as a Utilization Review Specialist (Remote), you need expertise in clinical guidelines, medical terminology, and case management, often backed by a nursing or healthcare-related degree and relevant licensure. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance policies or regulatory compliance is typically required. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for this role. These skills ensure accurate case evaluations, regulatory adherence, and effective collaboration with healthcare providers and payers.

How does a utilization review specialist typically collaborate with healthcare providers and insurance companies?

As a remote Utilization Review Specialist, you’ll frequently interact with healthcare providers and insurance representatives via phone, email, and secure digital platforms. Collaboration often involves reviewing patient records, clarifying clinical details, and ensuring documentation meets payer requirements. Maintaining clear, timely communication is crucial for resolving discrepancies and facilitating care authorizations. Most organizations utilize electronic health record (EHR) systems and case management software to streamline these interactions and support remote teamwork.
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Utilization Review Specialist Remote jobs near you
Infographic showing various Utilization Review Specialist Remote job openings in the United States as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 100% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

Utilization Management Specialist

System One

Baltimore, MD • Remote

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 25 days ago

Job description

Utilization Management Specialist (UM / Utilization Review Nurse) — Remote

Location: 100% Remote (U.S.) — Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension) Schedule: Mon–Fri, 8:00am–5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am–9:00am ET Pay (W2): USD 51.00/H

Job overview

In this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You’ll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.

What you’ll do

  • Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).
  • Make medical necessity / appropriateness determinations and support prior authorizations.
  • Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines).
  • Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines.
  • Research diagnoses/treatments and high-cost services; summarize findings and escalate complex cases to Medical Directors as needed.
  • Collaborate with internal partners and providers to support benefit application and appropriate levels/settings of care.
  • Maintain accurate documentation and protect PHI while managing a busy caseload.

Required qualifications

  • Active RN or LPN license (RN preferred) — Maryland compact/eligibility required
  • 5+ years clinical nursing experience
  • 2+ years care management / utilization management experience
  • MCG experience (required)
  • Experience supporting Commercial/FEP/Medicare lines of business and applying medical policy/regulatory standards
  • Strong critical thinking, written communication, and ability to work independently in a remote setting
  • Comfortable with web-based tools + Microsoft Office (Word/Excel/PowerPoint)
  • Guiding Care and FACETS (required)

Nice to have

  • Critical Care or ER clinical background
  • Experience with LCD/NCD, Medicare guidelines, ASAM, or other authorization criteria sets

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1