1:00 PM - 2:00 PM
Senior Product Manager Interview
Sarah Jenkins
Remote Utilization Review Nurse jobs in the United States
Job type
Min. salary, $/year
Level
Healthcare organizations across the USA are expanding their remote teams, fueling strong demand for utilization review nurse remote jobs. With 500+ open positions available now, nurses can apply their clinical expertise in care coordination and quality assurance from home, supporting hospitals and insurers eager to streamline patient care nationwide.
Successful candidates bring strong clinical judgment, a current RN license, and hands-on case management experience. Familiarity with InterQual or Milliman criteria, solid documentation skills, and clear communication with physicians and insurance providers are highly valued. Employers looking to hire a utilization review nurse often prioritize analytical thinking, compassionate patient advocacy, and comfort with electronic health record systems.
Remote work for these nurses typically involves flexible scheduling, secure access to case management platforms, and collaboration with multidisciplinary teams across time zones. As healthcare systems nationwide shift toward virtual care models, demand for utilization review nurse positions keeps climbing, especially among insurers and managed care organizations seeking experienced clinical talent.
If you are ready to advance your nursing career, explore the latest utilization review nurse vacancies through Global Work AI. Our platform connects dedicated healthcare professionals with organizations eager to find the right fit for this important role. Discover new remote opportunities today and take the next step in your career.
Sedgwick
Perform clinical assessments and evaluate patient conditions, including treatment utilization and compliance. Collaborate with physicians, claims examiners, and other parties to negotiate care levels.
remote, United States$63k – $65k/yrFull TimeJunior (<2 years)
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)
Centene Corporation
Analyze prior authorization requests for medical necessity and appropriate care levels. Collaborate with healthcare providers and teams to ensure timely service reviews. Document and maintain clinical information in health management systems, ensuring compliance with regulations.
remote, TX, United States$54k – $98k/yrFull 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)
Quantum Health, Inc.
Review and process coverage determinations and utilization management reviews for specialty medications. Collaborate with a multi-disciplinary clinical team, acquire clinical documentation, and communicate outcomes to members and providers.
remote, United States$60k/yrFull TimeJunior (<2 years)
Peraton
Conduct medical record reviews and apply clinical judgment to claim payment decisions. Perform research on medical claims data to identify issues and support fraud investigations.
remote, United States$51k – $82k/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)Health Plan of San Joaquin/Mountain Valley Health Plan
Conduct concurrent reviews of inpatient activities, ensuring compliance with care plans and regulatory requirements. Collaborate with providers to resolve care issues, make recommendations for transfers and discharge planning, and document activities in HPSJ systems.
remote, CA, United StatesFull TimeMiddle (2-4 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)
Northpoint Recovery Holdings, LLC
Coordinate the authorization process by managing pending, approved, denied, and expiring authorizations. Track and communicate authorization deadlines, collect and submit clinical documentation, and perform routine payer follow-ups.
remote, United States$40k – $50k/yrFull TimeEntry with Degree
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)
Oscar Health
Conduct medical reviews to determine appropriateness of inpatient, outpatient, and pharmacy services. Document decisions in workflow tools, ensuring clarity for members. Engage in peer-to-peer discussions with providers to clarify clinical information and explain review outcomes.
remote, United States$275k/yrFull TimeSenior (5+ 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
Sentara Health
Conduct utilization review services, including prior authorization for inpatient and outpatient reviews. Ensure compliance with treatment setting criteria and regulatory requirements. Communicate pertinent clinical information effectively, both in writing and verbally.
remote, WY, United States$90k – $136k/yrFull TimeMiddle (2-4 years)
WNS Global Services
Conduct concurrent inpatient utilization reviews using InterQual criteria to assess medical necessity for admissions and continued stays. Collaborate with clinical teams to gather information and support level-of-care decisions.
remote, United States$75k/yrFull TimeJunior (<2 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)
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)
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)
Prolific Academic Ltd
Complete expert registration and medical-credential verification through Prolific’s onboarding process. If qualified, apply experience in utilization review, utilization management, or physician clinical review to paid research and AI-related tasks.
remote, United States$262k/yrFull TimeJunior (<2 years)
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 / Manager
Excellus BCBS
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 TimeMiddle (2-4 years)CorVel Career Site
Gather demographic and clinical information for inpatient admissions and outpatient treatment. Certify medical necessity and assign appropriate lengths of stay. Analyze data to make certification or denial decisions and document all work accurately.
remote, United States$64k – $95k/yrFull TimeMiddle (2-4 years)
CorVel Corporation
Gather demographic and clinical information for inpatient admissions and outpatient treatment. Certify medical necessity and assign appropriate lengths of stay. Document all work accurately and communicate issues to claims staff.
remote, United States$64k – $95k/yrFull TimeMiddle (2-4 years)
SCAN Health Insurance
Review and analyze complex healthcare claims from a medical perspective. Conduct audits of medical claims, identify documentation needs, and interpret CMS guidelines.
remote, CA, United States$79k – $113k/yrFull TimeMiddle (2-4 years)
ePathUSA
Perform complex medical record and claim reviews for Medicare Part A and B, making coverage determinations based on policies and guidelines. Evaluate AI-assisted processes for compliance and support Program Integrity reviews to detect fraud, waste, and abuse.
remote, IA, United States$77k – $97k/yrFull TimeMiddle (2-4 years)
Dane Street, LLC
Ensure timely completion and accuracy of physician reports, evaluating quality against client standards. Communicate with clients and physicians to clarify report questions and gather necessary information.
remote, United StatesFull TimeEntry with Degree
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)
Astrana Health, Inc.
Conduct prior authorization and retrospective reviews for inpatient admissions, outpatient procedures, and durable medical equipment. Refer cases to Medical Directors as necessary and maintain compliance with state and federal regulations.
remote, TX, United States$60k – $81k/yrFull TimeJunior (<2 years)
Medica
Conduct medical record reviews and clinical quality audits to ensure compliance with quality standards. Collect and validate clinical documentation, prepare audit findings, and support quality programs through data abstraction.
remote, AR, United States$70k – $105k/yrFull TimeSenior (5+ years)
RediMinds, Inc
Review incoming case files for completeness and accuracy, validate system-generated summaries, quality-check clinicians’ written reviews, and perform final quality assurance on determination letters.
remote, United StatesFull TimeJunior (<2 years)
Ensemble Health Partners
Lead Utilization Review RN oversees patient care delivery, ensuring medical necessity and appropriate resource utilization. Responsibilities include conducting daily medical necessity reviews, coordinating denial management processes, and facilitating discharge planning.
remote, United States$79k – $107k/yrFull TimeSenior (5+ 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)
Machinify
Perform medical claims audit reviews for inpatient and outpatient services, applying medical review guidelines. Document findings and generate audit letters. Support findings during appeals and collaborate with the audit team to identify vulnerabilities.
remote, United StatesFull TimeSenior (5+ years)
All Care To You
Review authorization requests for medical necessity, documenting all steps in the authorization system. Process requests within established time frames, utilizing CMS and Health Plan criteria. Conduct retrospective reviews and refer cases to the Medical Director as needed.
remote, United StatesFull TimeSenior (5+ years)
Adolescent Wellness Academy
Verify insurance benefits and eligibility, complete prior authorizations and reviews, and support medical necessity using ASAM, LOCUS, and CALOCUS criteria. Obtain Single Case Agreements with out-of-network payers, submit denial appeals, and coordinate peer-to-peer reviews.
remote, United States$48k – $52k/yrFull TimeJunior (<2 years)
Tristar Insurance
Perform Workers’ Compensation utilization review including prospective, concurrent, expedited, and retrospective reviews to assess medical necessity. Evaluate treatment requests against clinical information and guidelines, referring to Peer Physicians as needed.
remote, United States$82k – $88k/yrFull TimeJunior (<2 years)
Gainwell Technologies LLC
Perform clinical reviews of medical records to assess medical necessity and appropriateness of care. Document review decisions and rationale, determine approvals, and process consultant decisions.
remote, United States$78k – $88k/yrFull TimeSenior (5+ years)Machinify
Perform medical claims audit reviews for government clients, ensuring compliance with medical review guidelines. Document findings, generate audit letters, and support findings during appeals. Collaborate with the audit team to identify vulnerabilities and improve medical policies.
remote, United StatesFull TimeSenior (5+ years)10,000,000+ more jobs available!
