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Utilization Review Specialist Remote Jobs (NOW HIRING)

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... For positions that are available as remote work, Sentara Health employs associates in the following ...

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 ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

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

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 ...

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

As of Sep 5, 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.

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.

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.
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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 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 $66,436 per year, or $31.9 per hour.

Registered Nurse-Utilization Review

3B Healthcare, Inc.

Torrance, CA • Remote

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Registered Nurse – Utilization Review (Remote)This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS).Minimum of 3 years acute medical Care Management/Utilization Review experience in a hospital setting (experience in health plans or medical groups is not applicable).InterQual experience is mandatory; candidates without this will not be considered. Proficient in Epic, with recent use within the last 6–12 months. Experience working with HMOs, IPAs, and similar managed care organizations. Strong knowledge of Medicare regulations and associated utilization management processes, including: Condition Code 44 (CC44)Advance Beneficiary Notices (ABNs)Hospital-Issued Notices of Noncoverage (HINNs)Medicare Coverage Status Notices (MCSNs)

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