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Sarah Jenkins
Remote Utilization Management Nurse jobs in the United States
Job type
Min. salary, $/year
Level
The demand for skilled utilization management nurses continues to grow across the USA, and 500+ utilization management nurse remote jobs are currently available for qualified registered nurses ready to make an impact from home. Healthcare organizations seek professionals who can streamline patient care while reducing costs, offering flexibility and meaningful work without geographic limitations.
Successful candidates typically bring strong clinical judgment, a valid RN license, and experience with review tools such as InterQual or MCG criteria. Excellent communication skills are essential for collaborating with physicians, insurers, and case managers, while attention to detail ensures accurate documentation and compliance with regulatory standards. Employers seeking to hire a utilization management nurse often value adaptability, critical thinking, and a solid understanding of healthcare reimbursement processes.
Remote utilization management nurse positions have become increasingly common as healthcare systems embrace telehealth and digital case management platforms. This shift allows nurses to work from home while maintaining strong connections with multidisciplinary teams, reflecting a broader national trend toward flexible, technology-driven healthcare roles. The growing reliance on remote review processes reflects a strong hiring outlook across the USA, with organizations continuously expanding their virtual nursing teams.
If you're ready to advance your nursing career from the comfort of your home, explore the latest utilization management nurse vacancies available through GlobalWork AI. Take the next step toward a rewarding, flexible career that makes a real difference in patient care today.
Humana
Coordinate and document medical services and benefit administration determinations. Utilize clinical knowledge to interpret criteria and policies for optimal treatment and care.
remote, IN, United States$78k – $108k/yrFull TimeMiddle (2-4 years)
Cottingham & Butler
Evaluate and pre-certify requests for hospital stays, outpatient surgeries, and tests by reviewing them against evidence-based guidelines. Handle multiple provider phone calls and ensure medically necessary services are provided at the right time.
remote, IA, United StatesFull TimeEntry with Degree
Providence
Conduct prospective, retrospective, and concurrent utilization reviews for Southern CA ministries. Perform clinical reviews and assess medical records daily during admissions for all payers as required by health plans.
remote, CA, United StatesPart TimeJunior (<2 years)
Cambia Health Solutions
Conduct case management activities including assessment, planning, implementation, coordination, monitoring, and evaluation of member needs. Collaborate with physician advisors and other departments to resolve claims and quality of care issues.
remote, IA, United States$75k – $102k/yrFull TimeMiddle (2-4 years)
HealthCare Strategies, Inc.
Collect personal and clinical information from Plan members, perform telephonic clinical assessments, and document calls accurately. Render initial determinations of medical appropriateness and identify individuals for case management.
remote, United StatesPart TimeJunior (<2 years)
LCMC Health
Develop individualized care plans, assess patient health status, identify treatment gaps, coordinate care, ensure discharge services, triage calls, manage home monitoring alerts, provide health information, document workflows in EPIC, and educate patients on wellness and disease management.
remote, LA, United StatesPart TimeJunior (<2 years)
Devoted Health
Manage intake queues, perform authorization set-up, and coordinate clinical workflows. Conduct outbound calls to gather clinical information and communicate decisions. Support care transitions and maintain accurate documentation in systems.
remote, United States$44k – $54k/yrFull TimeJunior (<2 years)
Intermountain Health
Conduct utilization review screenings, assessments, and evaluations to ensure appropriate benefit utilization and medical necessity. Collaborate with healthcare providers and patients to expedite authorizations and ensure compliance with regulatory guidelines.
remote, CO, United States$83k – $125k/yrPart TimeMiddle (2-4 years)
BlueCross BlueShield of South Carolina
Perform medical surgical/pharmacy reviews and utilization management of services within the LPN/LBSW scope. Document decisions using clinical guidelines, support medical claims review, and educate members on coverage determinations.
remote, SC, United StatesFull TimeJunior (<2 years)
Connecticut Children's
Conducts utilization reviews for assigned patients, ensuring compliance with medical necessity guidelines. Performs concurrent and retrospective clinical reviews, documents resource utilization, and collaborates with healthcare teams to optimize patient care.
remote, CT, United StatesFull TimeMiddle (2-4 years)
CommunityCare
Conduct clinical reviews of utilization requests for outpatient, inpatient, and post-acute services. Determine medical necessity using clinical review criteria and document review determinations.
remote, OK, United StatesFull TimeMiddle (2-4 years)
Adventist Health
Conduct clinical reviews of acute medical patients using the Optum/Inter Qual tool to assess treatment appropriateness. Collaborate with healthcare providers and insurance companies to develop patient care plans and ensure efficient resource utilization.
remote, CA, United StatesFull TimeSenior (5+ years)Providence
Manage and communicate clinically-based appeals between Providence Health and Services and outside payers. Advocate for reimbursement of services provided to patients. Ensure compliance and uniformity in patient-focused activities.
remote, CA, United StatesPart TimeMiddle (2-4 years)
Amerihealth Caritas
Create, write, edit, and complete utilization management review adverse decision notices and informational letters according to state/plan requirements. Oversee behavioral and physical health approval and denial letters for Medicaid, Medicare, and the Exchange.
remote, United StatesFull TimeMiddle (2-4 years)Amerihealth Caritas
Supervise a remote team of up to 15 Utilization Management Reviewers, providing daily oversight and support. Manage daily operations, including workflow and inventory of prior authorization requests.
remote, LA, United StatesFull TimeLead / Manager
WVU Medicine
Collaborate with the Medical Director to reduce care variance and ensure timely discharges. Implement care management review processes including Prior Authorization and Concurrent Reviews. Educate stakeholders to improve processes and enhance member healthcare outcomes.
remote, United StatesFull TimeMiddle (2-4 years)Amerihealth Caritas
Evaluate medical necessity for inpatient and outpatient services, ensuring compliance with clinical guidelines and regulations. Review provider requests, gather medical documentation, and make determinations based on clinical criteria.
remote, United StatesFull TimeMiddle (2-4 years)
WPS—A health solutions company
Evaluate medical services for efficiency and appropriateness, using clinical knowledge to authorize services based on evidence-based criteria. Refer questionable cases to medical directors and document case summaries.
remote, NC, United States$75k – $100k/yrFull TimeMiddle (2-4 years)
Naphcare, Inc.
Develop and administer quality assurance and utilization review processes. Monitor medical care quality, perform utilization and concurrent reviews, and conduct clinical chart assessments.
remote, AZ, United StatesFull TimeMiddle (2-4 years)
ResPro Health
Welcome patients into care programs, coordinate with respiratory therapists and providers, and educate patients on monitoring devices. Create personalized care plans, review device readings, and assist patients with healthcare navigation.
remote, FL, United States$55k – $65k/yrFull TimeJunior (<2 years)
Kindred Healthcare
Manage front-end prior authorizations and in-house concurrent review authorizations. Review medical records for authorization, coordinate with hospitals, and partner with case management teams. Generate appeals for denied authorizations and document authorization information in tracking systems.
remote, Las Vegas, NV, United StatesFull TimeMiddle (2-4 years)
Gallagher
Develop and execute the Nurse Case Management (NCM) and Nurse Triage strategy. Oversee NCM operations, ensuring clinical quality and resource utilization. Establish workflows and performance standards, promote coordination among stakeholders, and monitor service levels.
remote, Rolling Meadows, IL, United StatesFull TimeVP / C-level
company
Coordinate and monitor utilization of physical health services, ensuring compliance with standards. Perform clinical reviews to assess appropriateness of services, document utilization management activities, and advocate for members.
remote, NY, United States$62k – $118k/yrFull TimeLead / ManagerDevoted Health
Lead the Utilization Management (UM) operations, overseeing a large team of onshore and offshore UM Administrative Coordinators. Ensure SLA performance for authorization reviews, redesign administrative processes for efficiency, and collaborate with Product and Engineering on technology integration.
remote, United States$182k – $247k/yrFull TimeDirector
WelbeHealth
Oversee daily operations of the Utilization Management (UM) team, assist in reviewing prior-authorization requests, and ensure compliance with medical necessity standards.
remote, CA, United States$99k – $131k/yrFull TimeLead / ManagerBaystate Health
Lead a team of registered nurses and clinical support staff in utilization management services. Oversee quality improvement initiatives, operational performance, and regulatory compliance. Monitor team performance, implement corrective actions, and develop strategies for positive member outcomes.
remote, CT, United States$108k – $147k/yrFull TimeLead / Manager
Centene Corporation
Manage the Prior Authorization, Concurrent Review, and Appeals teams to ensure compliance with guidelines. Analyze utilization management activities to identify improvement areas and develop policies. Educate the team on key initiatives and provide coaching to ensure quality standards are met.
remote, OK, United States$87k – $161k/yrFull TimeLead / ManagerHealthCare Strategies, Inc.
Collect personal and clinical information from Plan members, perform telephonic Clinical Assessments, and render initial determinations of medical appropriateness. Document calls accurately, follow policies for handling confidential information, and complete medical necessity reviews.
remote, United StatesFull TimeJunior (<2 years)
University Health
Partner with interdisciplinary teams to optimize healthcare resource utilization. Monitor patient care delivery to ensure compliance with best practices and regulatory standards. Serve as a clinical consultant for utilization practices and discharge planning.
remote, MO, United StatesFull TimeJunior (<2 years)Cambia Health Solutions
Conduct utilization management reviews to ensure medical necessity and compliance with policies. Apply clinical expertise and evidence-based criteria for decision-making, collaborating with interdisciplinary teams.
remote, IA, United States$71k – $115k/yrFull TimeMiddle (2-4 years)
Clover Health
Evaluate outpatient referrals and inpatient admissions for medical appropriateness. Utilize Medicare Coverage Determinations and Clover Health’s medical policies to determine medical necessity. Support Utilization Management processes and quality improvement initiatives.
remote, United StatesFull TimeDirector
NeueHealth
Evaluate and process prior authorization requests based on clinical guidelines. Assess medical necessity and appropriateness of requested services. Communicate authorization decisions to providers and patients, and document all activities in electronic medical records.
remote, CA, United States$55k – $82k/yrFull TimeJunior (<2 years)
TruHealth
Assess medical necessity and quality of healthcare services through pre-service, concurrent, and retrospective reviews. Conduct outreach to providers for clinical data, apply clinical review criteria, and certify cases meeting guidelines.
remote, GA, United StatesFull TimeJunior (<2 years)
ArchWell Health
Conduct utilization reviews for medical necessity, ensuring appropriateness of treatments and services. Collaborate with healthcare providers and Medical Directors on health plan determinations.
remote, Nashville, TN, United StatesFull TimeMiddle (2-4 years)
Curana Health, Inc.
Review and monitor healthcare service utilization to ensure quality, cost-effective care. Conduct prior authorizations, concurrent reviews, and proactive discharge planning. Engage with providers for discharge plans and manage high dollar claims.
remote, United StatesFull TimeJunior (<2 years)
Cedars-Sinai
Provide operational support to Utilization Review Nurses, ensuring compliance and accuracy in the utilization review process. Manage authorization workflows, prepare clinical review packets, track submissions, and communicate payer determinations.
remote, Nevada, United StatesFull TimeJunior (<2 years)
Altais
Manage incoming authorizations through Tapestry Link and OnBase, ensuring eligibility verification and data entry. Serve as the primary contact for authorization inquiries, review requests, and prepare denial letters under supervision.
remote, United States$50k – $60k/yrFull TimeJunior (<2 years)
UnitedHealth Group
Review and extract case details from patient medical records, and compose appeal letters following departmental guidelines. Ensure compliance with HIPAA and company policies while maintaining quality and productivity standards.
remote, United States$58k – $105k/yrFull TimeMiddle (2-4 years)
Mountain Region Support
Lead the development and oversight of the Utilization Management program, ensuring compliance with regulatory standards. Oversee inpatient admission reviews, continued stay assessments, and appeals management.
remote, Kansas, United StatesFull TimeDirector
Integra Partners
Direct clinical and non-clinical utilization management teams, ensuring timely review of prior authorizations and appeals. Oversee quality improvement activities, conduct audits, and manage compliance with internal policies and regulatory standards.
remote, AZ, United States$160k/yrFull TimeDirector10,000,000+ more jobs available!
