Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines. * Communicates with healthcare teams and third ...
Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines. * Communicates with healthcare teams and third ...
Care Review Nurse
Columbus, OH · On-site
Care Review Nurse Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ...
Care Review Nurse
Columbus, OH · On-site
Care Review Nurse Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Utilization Review LVN/RN
Columbus, OH · On-site
Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...
Utilization Review LVN/RN
Columbus, OH · On-site
Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...
SUMMARY The Utilization Management Specialist is responsible for coordinating and managing all ... Monitors and reviews MCO portals to track authorization status, pending requests, approvals ...
Quick apply
SUMMARY The Utilization Management Specialist is responsible for coordinating and managing all ... Monitors and reviews MCO portals to track authorization status, pending requests, approvals ...
UR Coordinator, Full Time
Columbus, OH · On-site
$24 - $32/hr
About the Role RiverVista is seeking a detail-oriented and knowledgeable Utilization Review (UR) Coordinator to support clinical documentation, insurance authorization processes, and regulatory ...
UR Coordinator, Full Time
Columbus, OH · On-site
$24 - $32/hr
About the Role RiverVista is seeking a detail-oriented and knowledgeable Utilization Review (UR) Coordinator to support clinical documentation, insurance authorization processes, and regulatory ...
For billing and hospitalization utilization review purposes, the reviewer will identify and certify the acute hospitallength of stay authorized for each case. Initiate and maintain medical records ...
For billing and hospitalization utilization review purposes, the reviewer will identify and certify the acute hospitallength of stay authorized for each case. Initiate and maintain medical records ...
Nurse Case Manager
Columbus, OH · On-site
$55K - $110K/yr
One year of experience in nurse case management, medical case management, utilization review ... Flexible Work Arrangements - Hybrid and remote depending on the role We believe that happy, healthy ...
New
Nurse Case Manager
Columbus, OH · On-site
$55K - $110K/yr
One year of experience in nurse case management, medical case management, utilization review ... Flexible Work Arrangements - Hybrid and remote depending on the role We believe that happy, healthy ...
New
Appeals Registered Nurse
Columbus, OH · On-site
... Review, Utilization Management/Review, or Appeals preferred. * Basic Medicare knowledge and/or experience preferred. Remote Work Requirements * Wired (ethernet cable) internet connection from your ...
New
Appeals Registered Nurse
Columbus, OH · On-site
... Review, Utilization Management/Review, or Appeals preferred. * Basic Medicare knowledge and/or experience preferred. Remote Work Requirements * Wired (ethernet cable) internet connection from your ...
New
RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab plans ongoing until completion * Assess quality and clinical risk issues on a concurrent basis; report ...
Quick apply
RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab plans ongoing until completion * Assess quality and clinical risk issues on a concurrent basis; report ...
RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab plans ongoing until completion * Assess quality and clinical risk issues on a concurrent basis; report ...
RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab plans ongoing until completion * Assess quality and clinical risk issues on a concurrent basis; report ...
RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab plans ongoing until completion * Assess quality and clinical risk issues on a concurrent basis; report ...
Quick apply
RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab plans ongoing until completion * Assess quality and clinical risk issues on a concurrent basis; report ...
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
RN Case Manager - Prior Authorization
Columbus, OH · On-site
$30/hr
Utilization review, prior authorization, or managed care experience preferred. * Active OH RN Licensure * Experienced with either Interqual or Milliman Licenses/Certifications: Current RN, required.
RN Case Manager - Prior Authorization
Columbus, OH · On-site
$30/hr
Utilization review, prior authorization, or managed care experience preferred. * Active OH RN Licensure * Experienced with either Interqual or Milliman Licenses/Certifications: Current RN, required.
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Utilization review and or discharge planning experience preferred * Excellent verbal and written communication skills * Excellent computer skills. * LMH is accredited by DNV and TJC, and as such, may ...
Utilization review and or discharge planning experience preferred * Excellent verbal and written communication skills * Excellent computer skills. * LMH is accredited by DNV and TJC, and as such, may ...
Utilization review and or discharge planning experience preferred * Excellent verbal and written communication skills * Excellent computer skills. * LMH is accredited by DNV and TJC, and as such, may ...
Utilization review and or discharge planning experience preferred * Excellent verbal and written communication skills * Excellent computer skills. * LMH is accredited by DNV and TJC, and as such, may ...
Utilization review and or discharge planning experience preferred * Excellent verbal and written communication skills * Excellent computer skills. * LMH is accredited by DNV and TJC, and as such, may ...
Utilization review and or discharge planning experience preferred * Excellent verbal and written communication skills * Excellent computer skills. * LMH is accredited by DNV and TJC, and as such, may ...
Remote Utilization Review information
See salary details
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
How much do remote utilization review jobs pay per hour?
As of Aug 22, 2026, the average hourly pay for remote utilization review 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 are popular job titles related to Remote Utilization Review jobs?
For Remote Utilization Review jobs, the most frequently searched job titles are:
- Freelance Utilization Review Nurse
- Insurance Review Nurse
- Full Time Remote Utilization Review
- Utilization Review Specialist
- Evening Utilization Review Nurse
- Evening Optum Health Utilization Review
- Home Based Utilization Review Nurse
- Remote Utilization Review Nurse
- Per Diem Utilization Review Nurse
- Night Shift Remote Utilization Review Nurse
What job categories do people searching Remote Utilization Review jobs look for?
The top searched job categories for Remote Utilization Review jobs are:
- Work From Home Utilization Review
- Remote Hca Utilization Review
- Remote Weekend Utilization Review
- Remote Chiropractic Utilization Review
- Remote Navihealth Utilization Review
- Cigna Utilization Review Nurse
- Full Time Utilization Review Specialist
- Remote Physical Therapy Utilization Review
- Utilization Review
- Commission Authorization Utilization Review Bcba
What cities are hiring for Remote Utilization Review jobs?
Cities with the most Remote Utilization Review job openings:
What states have the most Remote Utilization Review jobs?
States with the most job openings for Remote Utilization Review jobs include:
What are the most commonly searched types of Utilization Review jobs?
The most popular types of Utilization Review jobs are:
Full-time
Re-posted yesterday
Nationwide Children's Hospital rating
6.9
Based on 131 frontline employees who took The Breakroom Quiz
549th of 1,061 rated hospitals
Job description
Overview:
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
Experience:
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
- Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines.
- Communicates with healthcare teams and third-party payors to ensure the delivery of quality care and optimum payment.
- Assists with retrospective reviews and denial management to maintain appropriate and cost-effective patient care.
- Documents all case reviews and maintains accurate records of all clinical activities and coverage information.
- Provides education and support regarding utilization review and management activities and processes.
- Analyzes clinical data to identify trends and patterns that may impact patient care. Participates in quality improvement initiatives to enhance the overall delivery of behavioral health services.
- Facilitates reimbursement by communicating with payers, other staff, patients, and families concerning status of funding and required actions.
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
- Excellent written and verbal communication and interpersonal skills.
- Excellent customer service and organizational skills.
- Working knowledge of CMS and other review agency standards.
- Proficient with software applications including CM, payer web applications, MITS, and others.
Experience:
- Three years of behavioral health experience, required.
- One year of experience in pediatric care or services, required.
- Utilization review or utilization management experience, preferred.
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
What Nationwide Children's Hospital employees say
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Get the full story on Breakroom
About Nationwide Children's Hospital
Sourced by ZipRecruiter
Nationwide Children's Hospital, established in 1894, is a leading pediatric healthcare system based in Columbus, Ohio, United States. They serve as a primary pediatric network, providing wellness, preventive, diagnostic, treatment, and rehabilitative care for infants, children, adolescents, and adults with congenital disease. Being the third-largest pediatric hospital in the nation, Nationwide Children's Hospital prides itself on its relentless commitment to children and their families, driven by their core values of respect, integrity, determination, empathy, and solidarity. The institution's comprehensive mission is to enhance the health of children by providing high-quality, family-centered care, conducting groundbreaking research, advocating for pediatric health, and training top healthcare professionals.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Columbus, OH, US
Year founded
1892