ZipRecruiter

Log In

2

Work From Home Utilization Management Technician Jobs

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

previous pagenext page

Showing results 21-40

All JobsUtilization Management Technician JobsWork From Home Utilization Management Technician Jobs

Work From Home Utilization Management Technician information

See salary details

$14

$24

$49

How much do work from home utilization management technician jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for work from home utilization management technician in the United States is $24.76, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $25.24 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a work from home utilization management technician, and why are they important?

To thrive as a Work From Home Utilization Management Technician, you need a solid understanding of medical terminology, healthcare processes, and typically a high school diploma or equivalent with experience in healthcare administration. Familiarity with utilization management software, electronic health records (EHRs), and insurance verification systems is usually required. Strong organizational skills, attention to detail, and effective written communication are crucial soft skills for this remote role. These skills and qualities enable accurate case processing, ensure compliance with healthcare regulations, and support efficient coordination between providers, payers, and patients.

What is a work from home utilization management technician?

A Work From Home Utilization Management Technician is a healthcare professional who reviews medical records and insurance claims remotely to ensure that patients receive appropriate care while maximizing the efficient use of healthcare resources. They work with nurses, physicians, and insurance companies to verify the medical necessity of procedures, treatments, and hospital stays. These technicians often use clinical guidelines and organizational policies to make determinations, document findings, and communicate with healthcare providers—all from a home office setting. This role requires strong attention to detail, knowledge of medical terminology, and the ability to work independently with confidential information.

How does a work from home utilization management technician typically collaborate with clinical and administrative teams while working remotely?

As a Work From Home Utilization Management Technician, collaboration with clinical staff, insurance coordinators, and administrative teams is primarily achieved through secure digital platforms such as email, chat, and virtual meetings. Most organizations use dedicated case management systems to share patient information, track authorizations, and communicate updates. Regular check-ins and team meetings ensure everyone stays aligned on priorities and any changes in policies. Despite being remote, you'll need strong communication skills and a proactive approach to maintain seamless workflow and support high-quality patient care.
More about Work From Home Utilization Management Technician jobs
What cities are hiring for Work From Home Utilization Management Technician jobs? Cities with the most Work From Home Utilization Management Technician job openings:
What states have the most Work From Home Utilization Management Technician jobs? States with the most job openings for Work From Home Utilization Management Technician jobs include:
What job categories do people searching Work From Home Utilization Management Technician jobs look for? The top searched job categories for Work From Home Utilization Management Technician jobs are:
Work From Home Utilization Management Technician jobs near you
Infographic showing various Work From Home Utilization Management Technician job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, and 4% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $51,508 per year, or $24.8 per hour.

RN Utilization Management Reviewer

Sagility LLC

Remote

$35 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 21 days ago

Sagility rating

4.6

Company rating: 4.6 out of 10

Based on 29 frontline employees who took The Breakroom Quiz

61st of 71 rated call and contact centers

Job description

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
Job title:
RN Utilization Management Reviewer
Job Description:
We are currently hiring a talented RN, Utilization Management Reviewer. This role will be responsible in day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS compliance standards in the area of service decisions and organizational determinations. Successful candidates must hold a valid, current license issued by the Massachusetts Board of Registration in Nursing.
Key responsibilities:
  • Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but not limited to surgical procedures, Medicare Part B medications, Long Term Services and Supports (LTSS), and Home Health (HH)
  • Applies established criteria (e.g., InterQual and other available guidelines) and employs clinical expertise to interpret clinical criteria to determine medical necessity of services
  • Communicates results of reviews verbally, in the medical record, and through official written notification to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements
  • Provides decision-making guidance to clinical teams on service planning as needed
  • Works closely with Clinicians, Medical Staff and Peer Reviewers to facilitate escalated reviews in accordance with Standard Operating Procedures
  • Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy
  • Works with UM Manager and other clinical leadership to ensure that departmental and organizational policies and procedures as well as regulatory and contractual requirements are met
  • Additional duties as requested by supervisor
  • Maintains knowledge of CMS, State and NCQA regulatory requirements

Education Requirements:
  • RN - Associate's Degree required, Bachelor's Degree preferred
  • RN, current license issued by the Massachusetts Board of Registration in Nursing
  • CCM (Certified Case Manager) a plus

Required Experience (must have):
  • 1 to 2 years Utilization Management experience.
  • 2 or more years working in a clinical setting

Desired Experience (nice to have):
  • 2 or more years of Home Health Care experience
  • 2 or more years working in a Medicare Advantage health Plan

Required Knowledge, Skills & Abilities (must have):
  • Ability to complete assigned work in a timely and accurate manner
  • Knowledge of the Utilization management process
  • Ability to work independently

Desired Knowledge, Skills, Abilities & Language (nice to have):
  • Ability to apply predetermined criteria (e.g., Medical Necessity Guidelines, InterQual) to service decision requests to assess medical necessity
  • Flexibility and understanding of individualized care plans
  • Ability to influence decision making
  • Strong collaboration and negotiation skills
  • Strong interpersonal, verbal, and written communication skills
  • Comfort working in a team-based environment
  • Knowledge of Medicare and Mass health services and benefits

Salary: $35.00 - $40.00 Hourly pending experience
Hours: Monday through Friday 9AM to 5:30PM Eastern Time. May require weekends
This is a fully remote work at home role. You must have a secure, private wok at home area with a hardwired internet connection with speeds greater than 5MB upload and 10MB download.
Sagility Offers Competitive Benefits Including:
  • Medical
  • Dental
  • Vision
  • Life Insurance
  • Short-Term and Long-Term Disability
  • Flexible Spending Account
  • Life Assistance Program
  • 401K with employer contribution
  • PTO and Sick Time
  • Tuition Reimbursement

Join our team, we look forward to talking with you!
An Equal Opportunity Employer/Vet/Disability
Location:
Work@Home USAUnited States of America

What Sagility employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply