ZipRecruiter

Log In

2

Work From Home Utilization Review Jobs (NOW HIRING)

Dane Street

PRN Utilization Review Nurse Reviewer

... for utilization review. * Apply clinical reasoning to determine the suitable evidence-based ... WORK FROM HOME TECHNICAL REQUIREMENTS: Supply and support their own internet services. Maintaining ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... While your daily work will be completed from your home office, occasional travel may be required ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... While your daily work will be completed from your home office, occasional travel may be required ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... While your daily work will be completed from your home office, occasional travel may be required ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... While your daily work will be completed from your home office, occasional travel may be required ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

Silver Cross Hospital is an extraordinary place to work. We're known for our culture of excellence ... Collects information from clinical medical record for severity of illness and intensity of service ...

University of Utah

Utilization Review Nurse

Demonstrated availability to work variable and rotating shifts, including nights, weekends, and ... One year Utilization Review or Case Management experience. Licenses Required * Current license to ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

Participate in discharge planning for members transitioning from acute, long-term, or residential ... Ability to work independently in fast-paced environments Schedule Monday through Friday - 8:00am ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

Participate in discharge planning for members transitioning from acute, long-term, or residential ... Ability to work independently in fast-paced environments SCHEDULE Monday through Friday - 8:00am ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

Participate in discharge planning for members transitioning from acute, long-term, or residential ... Ability to work independently in fast-paced environments SCHEDULE Monday through Friday - 8:00am ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

This position is responsible for performing initial, concurrent review activities; discharge care ... Provides information regarding utilization management requirements and operational procedures to ...

previous pagenext page

Showing results 21-40

All JobsUtilization Review JobsWork From Home Utilization Review Jobs

Work From Home Utilization Review information

See salary details

$15

$31

$53

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

As of Aug 10, 2026, the average hourly pay for work from home utilization review 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 are some common challenges faced by work from home utilization review professionals, and how can they be managed?

Work From Home Utilization Review professionals often face challenges such as maintaining effective communication with healthcare providers and team members, managing time efficiently without in-person supervision, and navigating multiple electronic health record systems remotely. To manage these challenges, it’s important to establish clear communication channels, set structured daily routines, and stay updated with technology training. Many organizations offer virtual team meetings and resources to support remote collaboration and continuous professional development.

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

To thrive as a Work From Home Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) are often required. Exceptional communication, critical thinking, and time management skills help in effectively coordinating care and interacting with patients and providers remotely. These skills ensure accurate and efficient reviews, compliance with guidelines, and optimal patient outcomes while working independently.

What is a work from home utilization review?

A Work From Home Utilization Review job involves evaluating the necessity, appropriateness, and efficiency of medical services provided to patients, typically for insurance companies or healthcare organizations. Employees in this role review patient records, treatment plans, and medical claims to ensure compliance with established guidelines and standards. Working remotely, these professionals often communicate with healthcare providers, patients, and insurance representatives to gather information and make recommendations regarding coverage or continued care.

What is the difference between Work From Home Utilization Review vs Work From Home Medical Coder?

AspectWork From Home Utilization ReviewWork From Home Medical Coder
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical reviewer credentialsRequires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentRemote, often involves reviewing medical records and insurance claimsRemote, involves reviewing and assigning medical codes to patient records
Industry UsageCommon in insurance, healthcare administration, and utilization managementCommon in medical billing, coding, and healthcare documentation

Work From Home Utilization Review and Work From Home Medical Coder roles both operate remotely within the healthcare industry. While utilization reviewers focus on assessing the necessity of medical services, medical coders assign standardized codes to patient records. Both require healthcare-related certifications and are essential for healthcare administration, but they differ in daily tasks and specific credentials.

More about Work From Home Utilization Review jobs
What cities are hiring for Work From Home Utilization Review jobs? Cities with the most Work From Home Utilization Review job openings:
What states have the most Work From Home Utilization Review jobs? States with the most job openings for Work From Home Utilization Review jobs include:
What job categories do people searching Work From Home Utilization Review jobs look for? The top searched job categories for Work From Home Utilization Review jobs are:
Work From Home Utilization Review jobs near you
Infographic showing various Work From Home Utilization Review job openings in the United States as of August 2026, with employment types broken down into 77% Full Time, 12% Part Time, and 11% Contract. Highlights an 2% In-person, and 98% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

PRN Utilization Review Nurse Reviewer

Dane Street, LLC

Remote

Full-time, Per diem

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Job description

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments.
Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways.
Our PRN Nursing Program is designed for flexible, as-needed staffing to support our team during peak times, weekends, and holidays.
  • PRN nurses will be required to work at least one weekend per month, one major holiday, and one minor holiday per year.
  • A minimum number of shifts per month will be mandated to ensure that PRN nurses maintain their QA skills and familiarity with processes.

MAJOR DUTIES & RESPONSIBILITIES
  • Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
  • Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
  • Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
  • Input and manage essential clinical details within various medical management platforms.
  • Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
  • Apply clinical reasoning to determine the suitable evidence-based guidelines.
  • Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements
  • Proficient in both written and spoken communication.
  • Capable of maintaining professional communication with physicians and clients.
  • Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
  • Possesses a keen organizational sense and pays close attention to details.
  • Adept at resolving intricate and multifaceted problems.
  • Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
  • Background in medical or clinical practice through education, training, or professional engagement.
  • Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Additional Duties
  • May provide oversight to the work of the team members.
  • Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction.
  • Responsible for the final approval on cases for release to the client.
  • Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.

EDUCATION/CREDENTIALS:
Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.
JOB RELEVANT EXPERIENCE:
2 yrs minimum clinical nursing experience is required.
One year of previous experience in Utilization Management is required.
JOB RELATED SKILLS/COMPETENCIES:
Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.
WORK FROM HOME TECHNICAL REQUIREMENTS:
Supply and support their own internet services.
Maintaining an uninterrupted internet connection is a requirement of all work from home position.
Requirements
Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.
Our Commitment:
We are committed to providing fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees.
Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Apply