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Work From Home Utilization Review Jobs (NOW HIRING)

RN Utilization Review

Austin, TX · Remote

$84.06K - $118.67K/yr

Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state ... Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold ...

Ability to work as a team player and assist other members of the team where needed. * Thrive in a ... Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used.

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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 May 30, 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 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 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 is a Work From Home Utilization Review job?

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:
Infographic showing various Work From Home Utilization Review job openings in the United States as of May 2026, with employment types broken down into 78% Full Time, 11% Part Time, and 11% Contract. Highlights an 5% In-person, and 95% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.
RN Utilization Review

RN Utilization Review

Ascension

Austin, TX • Remote

$84.06K - $118.67K/yr

Full-time

Medical, PTO

Posted 11 days ago


Ascension Healthcare rating

6.9

Company rating: 6.9 out of 10

Based on 993 frontline employees who took The Breakroom Quiz

447th of 864 rated healthcare providers


Job description

Your future role at a glance

Location: Remote

Facility: Ascension Network Services

Department: Utilization Management

Schedule: Full Time l Day

Salary range: $84,060.91 - $118,668.99 per year (Texas) | Pay ranges vary based on candidate geographic location

:

How you'll make an impact in this role
  • Provide healthcare services related to admissions, case management, discharge planning, and utilization review.
  • Review admissions and service requests for medical necessity, reimbursement compliance, and utilization management criteria.
  • Support complex case management and assist staff with coding, documentation, precertification, reimbursement, and denial/appeal issues.
  • Coordinate discharge planning needs with patients, providers, and interdisciplinary healthcare teams.
  • Ensure compliance with federal regulations and third-party payer utilization management requirements while preparing reports and statistical analyses as needed.
What minimum qualifications you'll need

Licensure / Certification / Registration:

  • Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date required.

Education:

  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Life at Ascension: Where purpose meets opportunity

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and supportive environment where your contributions truly matter.

Equal employment opportunity employer

Equal employment opportunity employer

Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

Fraud prevention notice

Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.

E-Verify statement

Employer does not participate in E-Verify and therefore cannot employ STEM OPT candidates.

Benefits

Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.

Employment Type: FULL_TIME

What Ascension Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom


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About Ascension

Sourced by ZipRecruiter

Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Industry

Health care and social assistance and outpatient health care

Company size

10,000+ Employees

Headquarters location

St. Louis, MO, US