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Remote Rn Utilization Review Nurse Jobs in Columbus, OH

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Remote Rn Utilization Review Nurse information

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$20

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$66

How much do remote rn utilization review nurse jobs pay per hour?

As of Jun 16, 2026, the average hourly pay for remote rn utilization review nurse in Columbus, OH is $40.84, according to ZipRecruiter salary data. Most workers in this role earn between $32.26 and $46.92 per hour, depending on experience, location, and employer.

What is the difference between Remote Rn Utilization Review Nurse vs Remote Rn Case Manager?

AspectRemote Rn Utilization Review NurseRemote Rn Case Manager
CertificationsRN license, possibly UR or CCM certificationRN license, CCM or other case management certification
Work EnvironmentReviewing medical records, insurance guidelines, and authorizationsCoordinating patient care, discharge planning, and resource management
Employer & Industry UsageHealth insurance companies, third-party administratorsHospitals, health plans, healthcare providers

Remote Rn Utilization Review Nurses primarily evaluate medical necessity for insurance approvals, focusing on documentation and guidelines. In contrast, Remote Rn Case Managers coordinate patient care, discharge planning, and resource allocation. Both roles require RN licensure and related certifications but differ in daily tasks and work focus.

What is a Remote RN Utilization Review Nurse?

A Remote RN Utilization Review Nurse is a registered nurse who evaluates medical records and healthcare services from a remote location to ensure that patients receive appropriate, necessary, and cost-effective care. They review treatment plans, check for compliance with insurance and healthcare guidelines, and often work with healthcare providers, insurance companies, and patients to coordinate care. This role typically involves assessing the medical necessity of procedures, authorizing services, and helping prevent unnecessary treatments or hospitalizations.

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

To thrive as a Remote RN Utilization Review Nurse, you need an active RN license, strong clinical knowledge, and experience in case management or utilization review. Proficiency with healthcare review software, electronic health records (EHRs), and familiarity with insurance guidelines or regulatory requirements is vital. Excellent communication, critical thinking, and time management skills distinguish top performers in remote settings. These skills enable nurses to make accurate, timely decisions about patient care while ensuring compliance and efficient resource utilization.

What are some common challenges faced by Remote RN Utilization Review Nurses, and how can they be addressed?

Remote RN Utilization Review Nurses often encounter challenges such as managing large caseloads, maintaining effective communication with interdisciplinary teams, and staying updated with ever-changing insurance guidelines. Balancing productivity expectations while ensuring thorough case reviews can be demanding. To address these challenges, nurses can utilize robust organizational tools, participate in ongoing training sessions, and leverage regular virtual meetings to stay connected with colleagues and supervisors, ensuring both efficiency and high-quality patient care.
What are the most commonly searched types of Rn Utilization Review Nurse jobs in Columbus, OH? The most popular types of Rn Utilization Review Nurse jobs in Columbus, OH are:
What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Columbus, OH? For Remote Rn Utilization Review Nurse jobs in Columbus, OH, the most frequently searched job titles are:
What job categories do people searching Remote Rn Utilization Review Nurse jobs in Columbus, OH look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs in Columbus, OH are:
Remote Rn Utilization Review Nurse jobs near you
Utilization Review Specialist

Utilization Review Specialist

Lighthouse Behavioral Health Solutions

Columbus, OH

Other

Posted 6 days ago

Job description

Position: Utilization Review Specialist

Job Summary: The Utilization Review (UR) Specialist is responsible for ensuring that clients receiving substance use disorder (SUD) treatment services meet clinical criteria for admission, continued stay, and discharge. This role supports compliance with payer requirements, maintains proper documentation, and collaborates with clinical and administrative teams to maximize reimbursement while ensuring high-quality, medically necessary care.

Reports to: VP of Revenue Cycle Management

Duties and Responsibilities:

Duties include, but are not limited to:

  • Conduct initial and concurrent reviews to determine medical necessity using established criteria
  • Submit authorization requests and clinical documentation to insurance providers in a timely manner
  • Monitor authorizations and ensure services rendered align with approved levels of care
  • Track and manage authorization expirations and initiate reauthorization requests as needed
  • Review clinical records for completeness, accuracy, and compliance with payer and regulatory standards
  • Ensure treatment plans, progress notes, and discharge summaries support medical necessity
  • Provide feedback to clinical staff to improve documentation quality
  • Maintain adherence to HIPAA and confidentiality regulations
  • Serve as the primary liaison between the organization and insurance companies for utilization review matters
  • Participate in peer-to-peer reviews when required
  • Address denials by gathering supporting documentation and submitting appeals
  • Stay current with payer guidelines and regulatory changes affecting SUD services
  • Collaborate with clinical, admissions, billing, and case management teams to ensure continuity of care and proper utilization of services
  • Participate in multidisciplinary team meetings to discuss patient progress and level-of-care needs
  • Communicate authorization status and payer requirements to relevant staff
  • Maintain accurate records of authorizations, denials, and appeals
  • Track utilization metrics and identify trends to improve efficiency and reimbursement
  • Participate in audits and quality assurance initiatives
  • Perform other duties as assigned

Required Experience/Abilities:

  • Bachelor's degree in behavioral health, nursing, social work, or a related field required.
  • Knowledge of ASAM Criteria required
  • Minimum of 1 year of experience in utilization review, case management, or clinical services within behavioral health or SUD treatment
  • Experience working with commercial insurance, Medicaid, and/or Medicare preferred
  • Familiarity with electronic health record (EHR) systems
  • Must pass BCI check, all Corporate Compliance checks, and employment drug screen

Desired Experience/Abilities:

  • Master's degree or clinical licensure (e.g., LSW, LPC, LCSW, RN) preferred.3 years in a supervisory or management role within a behavioral health setting
  • Working knowledge of CPT and ICD-10 coding systems, with relevant certification (e.g., CPC, CCS-P) or equivalent experience
  • Understanding of medical necessity criteria, including experience with InterQual and/or Milliman (MCG) guidelines

Location: Columbus, OH

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