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Utilization Review Substance Abuse Remote Jobs (NOW HIRING)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

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 ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

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 ...

Winston Medical Staffing

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Utilization Review Nurse

Newark, NJ · Remote

$38 - $40/hr

Position is 100% remote but will have to go to Newark, NJ to pick up equipment and short ... Serves as mentor/trainer to new RN's and other staff as needed, completes audits, reviews and ...

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

Remote : Mondays and Fridays * On-site in our Denver Office: Tuesdays, Wednesdays, and Thursdays The compensation range for this position is based upon candidate experience and market expectations.

VIVA USA INC

Utilization Review Nurse

Albuquerque, NM · On-site +1

Position Overview Remote position in any state except, NY, CA, HI, or AK Summary This Position Is ... Review Service Requests, Collect Clinical And Non-Clinical Data, Verify Eligibility, Determine ...

Pacer Group

RN - UTILIZATION REVIEW

Everett, WA · Remote

$65/hr

Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30) Shift Notes: Days (5×8 ...

Enterprise Engineering

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Concurrent Utilization Review (UR) Nurse

OR · Remote

$28 - $32/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 ...

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Utilization Review Substance Abuse Remote information

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How much do utilization review substance abuse remote jobs pay per hour?

As of Jun 14, 2026, the average hourly pay for utilization review substance abuse remote 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 the difference between Utilization Review Substance Abuse Remote vs Utilization Review Nurse?

AspectUtilization Review Substance Abuse RemoteUtilization Review Nurse
CredentialsLicensed Substance Abuse Counselor or similar certificationRegistered Nurse (RN) license, often with case management or utilization review training
Work EnvironmentRemote, primarily telehealth and administrative settingsRemote or onsite, hospital or insurance company settings
Industry UsageFocused on substance abuse treatment and insurance authorizationBroader healthcare utilization review, including various medical conditions
Common Search IntentComparing remote substance abuse review rolesUnderstanding utilization review nursing roles in healthcare

Utilization Review Substance Abuse Remote specialists focus on evaluating substance abuse treatment cases remotely, often requiring counseling credentials. Utilization Review Nurses have a broader scope, reviewing various medical cases, including substance abuse, with nursing credentials. Both roles involve assessing medical necessity but differ in certification, work environment, and specific focus areas.

How does a Utilization Review Substance Abuse Remote professional typically collaborate with treatment teams while working remotely?

Utilization Review professionals specializing in substance abuse often collaborate closely with clinicians, case managers, and administrative staff through secure digital platforms. Despite working remotely, they participate in virtual case conferences, review patient progress notes electronically, and communicate treatment recommendations via email or video meetings. This remote setup requires strong communication skills and familiarity with electronic health records to ensure timely and accurate assessments, helping the team make informed decisions about patient care and insurance authorizations.

What is a Utilization Review Substance Abuse Remote position?

A Utilization Review Substance Abuse Remote position involves evaluating patient records and treatment plans related to substance abuse to ensure that care is medically necessary and meets insurance or regulatory guidelines. These professionals typically work from home, reviewing documentation submitted by treatment providers, and determining if services are appropriate, cost-effective, and compliant with policies. The role often requires collaboration with healthcare teams, insurance companies, and sometimes patients, to approve or deny coverage for specific treatments. Strong knowledge of substance abuse disorders, treatment modalities, and insurance criteria is essential.

What are the key skills and qualifications needed to thrive as a Utilization Review Substance Abuse Remote specialist, and why are they important?

To excel in a Utilization Review Substance Abuse Remote role, you need a background in behavioral health, strong clinical assessment abilities, and typically a relevant license (such as RN, LCSW, or LPC). Familiarity with medical record systems, utilization management software, and knowledge of insurance and regulatory guidelines is crucial. Excellent communication, critical thinking, and attention to detail enable effective collaboration with care teams and accurate documentation. These skills ensure appropriate care delivery, regulatory compliance, and optimal patient outcomes in a remote environment.

REMOTE Utilization Review Nurse - Managed Care

DOCS Management Services

Coos Bay, OR • Remote

$35.29 - $47.37/hr

Full-time, Part-time

Medical

Posted 29 days ago

Job description

We are currently hiring a Part-time REMOTE Utilization Review Nurse! If you are a licensed nurse with excellent critical thinking skills, have experience in acute care settings and utilization review, and value being part of a team that makes a difference, you may be the right person for the position! Apply today!

Classification: NON-EXEMPT | Status amp; Schedule: PART-TIME, 20-HRS/WEEK, GENERALLY MONDAY – FRIDAY, BUT MAY INCLUDE ADDITIONAL HOURS TO MEET THE NEEDS OF THE POSITION
Location: REMOTE, LOCAL TO OREGON STRONGLY PREFERRED
Work Location: OR, CA, AZ, TX, FL
Salary: $35.29 - $47.37/HOURLY
Department: MEDICAL SERVICES/UTILIZATION REVIEW | Reports to: DIRECTOR OF MEDICAL SERVICES | Supervision Exercised: NON-SUPERVISORY
JOB PURPOSE: Utilization Review Nurse
The Clinical Review Nurse is responsible for providing clinically efficient and effective utilization management. Reviews prior authorization requests for appropriate care and setting by following evidence based clinical guidelines, medical necessity criteria and health plan guidelines. Reviews and applies hierarchy of criteria to all referral and preauthorization requests from the PCP's and specialists that require a medical necessity determination. Is involved in assuring that the patient receives high-quality cost-effective care. Uses sound clinical judgement and managed care principles in the coordination of care. Prepares any case that does not meet medical necessity guidelines for medical appropriateness of procedure, service, or treatment for review with the Physician Reviewer for a decision.
QUALIFICATIONS, EDUCATION, and EXPERIENCE
  • Nursing degree from an accredited nursing program
  • Unrestricted Oregon RN license
  • Experience with a similar population in health plans or managed care
  • Experience administering OHP, Medicare benefits or utilization review highly preferred.
ESSENTIAL RESPONSIBILITIES: Licensed Utilization Review
  1. Maintains clinical expertise and knowledge of scientific progress in nursing and medical arena and incorporates this information into the clinical review and care coordination processes
  2. Performs clinical review for appropriate utilization of medical services by applying appropriate medical necessity criteria guidelines
  3. Authorizes healthcare services in compliance with contractual agreements, Health Plan guidelines and appropriate medical necessity criteria
  4. Provides accurate and timely documentation within internal system supporting rational of decision based on clinical review
  5. Identifies members who are appropriate for care coordination programs and collaborates with the Medical Management team for care coordination of the member's needs along the continuum of care
  6. Meets timeliness standards for referral and prior authorization activities
  7. Sends appropriate notifications for Third Party Liability (TPL) and/or possible Stop Loss
  8. Forward relevant information of members requiring special interventions to Advanced Health
  9. Participate in quality and organizational process improvement activities and teams when requested
  10. Assist in audit preparation as directed
  11. Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
  12. Handle confidential information and materials appropriately and maintains a secure work area
  13. Maintains the confidentiality of all company procedures, results, and information about patients, contracts, and all other proprietary information regarding company business.
  14. Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
  15. Handle confidential information and materials appropriately and maintain a secure work area
  16. Other duties as assigned
ESSENTIAL RESPONSIBILITIES: ORGANIZATIONAL TEAM MEMBER
  • Participate in quality and organizational process improvement activities and teams when requested
  • Support and contribute to effective safety, quality, and risk management efforts by adhering to established; policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities
  • Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner
  • Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization
  • Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations
  • Recognize new developments and remain current in [position’s expertise] best practice standards and anticipate organizational modifications
  • Advance personal knowledge base by pursuing continuing education to enhance professional competence
  • Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
  • Represent organization at meetings and conferences as applicable
KNOWLEDGE, SKILLS, and ABILITIES
  • Knowledge of OHP program requirements, benefit package, eligibility categories, and Oregon Division of Medical Assistance Program (MAP) rules and regulations preferred
  • Knowledge of ICD, CPT, and HCPCS codes
  • Proficient in Milliman Clinical Guidelines (MCG)
  • Strong attention to detail
  • Ability to think and work independently with minimum supervision
  • Provide critical attention to detail for accuracy and timeliness
  • Ability to manage multiple tasks and remain flexible in a dynamic work environment
  • Ability to report to work as scheduled, and willingness to work a flexible schedule when needed
  • Proficient in Microsoft Office Suite and Windows Operating System (OS)
  • Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access
  • Knowledge and understanding of how the positions’ responsibilities contribute to the department and company goals and mission
  • Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
  • Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices
  • Excellent people skills and friendly demeanor
  • Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
  • Attention to detail and organization skills
  • Ability to handle stress and sensitive situations effectively while projecting a professional attitude
  • Ability to communicate professionally, both conversing and written
  • Ability to work with diverse populations and interact with people of differing personalities and backgrounds
  • Sensitive to economic considerations, human needs and aware of how one’s actions may affect others
  • Ability to organize and work in a sensitive manner with people from other cultures
  • Poised; maintains composure and sense of purpose
WORKING CONDITIONS
This position must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information.
Work Condition: Remote Work Environment
  • Employee generally works within a remote work from home environment.
  • Travel may be required on occasion.
  • Hours of operations and specific staff scheduling may vary based on operational need.
Exposed to:
  • Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output.
  • Machines, equipment, tools, and supplies used: Constantly operates a computer or other office productivity machinery or software, such as fax, copier, calculator, multi-line telephone system, or scanner.
  • May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information.
Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task.
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of DOCS Management Services employees. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

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