Selected: ✨ Utilization Review Nurse.
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Selected: 🆕 Date Added.
🔥 4 hours ago
Utilization management nurse reviewing outpatient authorizations for Devoted Health’s Medicare Advantage members. Applying CMS criteria, documenting determinations, and escalating complex cases for physician review.
🔥 9 hours ago
Utilization Management Nurse Consultant reviewing Medicare coverage and coordinating member care for CVS Health. Applying clinical criteria to coverage determinations in a remote Texas role.
🔥 9 hours ago
CVS Health utilization management RN reviewing Medicare complex spine cases and making evidence-based coverage decisions. Coordinating treatment with providers to improve member outcomes.
🔥 12 hours ago
CVS Health utilization management nurse reviewing Medicare complex-spine cases and making evidence-based coverage decisions. Coordinating treatment with providers to improve member care quality and outcomes.
🏈 Alabama, Arizona, +26 more states – Remote
💵 $26 - $56 / hour
⏰ Full Time
🟡 Mid-level
🟠 Senior
💼 Consultant
👻 Ghost score 0%
🔥 12 hours ago
Remote RN utilization review care manager reviewing medical necessity and authorizations for Intermountain Health. Coordinating safe, cost-effective care transitions with providers, patients, and families.
🔥 18 hours ago
Utilization Review Nurse conducting clinical reviews and medical-necessity determinations for Connecticut Children’s pediatric health system. Supporting efficient, compliant care and resource utilization.
🦌 Connecticut – Remote
💵 $42 - $63 / hour
⏰ Full Time
🟡 Mid-level
🟠 Senior
🦅 H1B Visa Sponsor
👻 Ghost score 2%
🕒 3 days ago
Utilization Management Nurse Consultant assessing member coverage and coordinating healthcare benefits for CVS Health. Remote weekend role applying clinical criteria and collaborating with providers.
🌲 North Carolina – Remote
💵 $26 - $68 / hour
⏰ Full Time
🟡 Mid-level
🟠 Senior
💼 Consultant
👻 Ghost score 0%
🕒 5 days ago
Remote Utilization Management Nurse Consultant for CVS Health, reviewing medical necessity and coverage decisions. Coordinating care, referrals, and transitions for Florida members.
🕒 6 days ago
Remote Utilization Review Coordinator supporting authorization operations for Northpoint Recovery’s behavioral healthcare services. Tracking payer approvals, documentation, and clinical record submissions.
🕒 6 days ago
Remote nurse manager leading Ascension’s utilization review operations, staffing, quality programs, and patient placement decisions. Supporting regulatory, financial, and clinical outcomes.
🇺🇸 United States – Remote
💵 $89.9k - $162.1k / year
⏰ Full Time
🟡 Mid-level
🟠 Senior
🦅 H1B Visa Sponsor
👻 Ghost score 0%
🕒 6 days ago
CVS Health Utilization Management Nurse Consultant assessing member care and coverage decisions remotely. Coordinating providers, clinical criteria, referrals, and benefit utilization.
🕒 6 days ago
Medical Review Nurse analyzing clinical data, catastrophic claims, and reserves for Novacore’s employer stop-loss insurance business. Supporting underwriting, claims, and risk mitigation.
🕒 November 3
Physician Reviewer evaluating medical necessity for inpatient, outpatient, and pharmacy services at Oscar Health. Applying evidence-based guidelines and documenting utilization-management decisions.
🌵 Arizona, Florida, +1 more states – Remote
💵 $275k / year
💰 $355M Post-IPO Debt - Oscar Health on 2025-09
⏰ Full Time
🟡 Mid-level
🟠 Senior
🦅 H1B Visa Sponsor
👻 Ghost score 0%
🕒 October 30
Remote utilization review case manager gathering clinical data and certifying treatment medical necessity. Supporting CorVel’s workers’ compensation and risk management solutions.
🏄 California – Remote
💵 $63.7k - $95.3k / year
⏰ Full Time
🟡 Mid-level
🟠 Senior
👔 Manager
🦅 H1B Visa Sponsor
👻 Ghost score 0%
🕒 October 30
Remote Utilization Review Nurse reviewing hospital admissions and continued stays for medical necessity. Supporting compliant patient status decisions, denial prevention, and reimbursement.
🕒 October 30
Remote PRN Utilization Review Nurse conducting acute-care admission and continued-stay reviews. Supporting medical necessity, denial prevention, compliance, and reimbursement for Brundage Medical Group.
🕒 October 30
Remote Utilization Review Nurse conducting hospital admission and continued-stay reviews. Supporting medical necessity, payer compliance, denial prevention, and reimbursement for Brundage Medical Group.
🕒 October 30
Utilization Management RN conducting telephonic clinical assessments and medical necessity reviews. Supporting HealthCare Strategies’ technology-enabled medical management and health management services.
🕒 October 29
QA Specialist reviewing oncology-related medical reports for accuracy, clinical rationale, and client compliance. Supporting Dane Street’s insurance-claims and peer-review services.
🕒 October 29
Utilization Management Nurse conducting clinical reviews for Cambia’s person-focused health care system. Applying evidence-based criteria and coordinating transitions of care remotely across four states.
🥔 Idaho, Oregon, +2 more states – Remote
💵 $31 - $51 / hour
⏰ Full Time
🟡 Mid-level
🟠 Senior
👻 Ghost score 0%
+33 More Utilization Review Nurse Jobs Available!
The average salary for remote utilization review nurses is $84,144 per year. This is based on data from 23 job openings. Our advanced AI searches the internet for remote job openings and posts them on our website. We use the salary data from these job postings to calculate salary expectations.
Below is a breakdown of salary data by years of experience:
| Experience | Number of roles analyzed | Average Salary |
|---|---|---|
🟡 Mid-level Utilization Review Nurse (2-4 yrs) | 23 | $84,144 |
We analyzed 17 job listings in the last year and found it takes about 28 days for employers to close a job opening.
We reviewed 29 job postings and found the top 10 skills employers are asking for most often are:
You need strong critical thinking and analytical skills, attention to detail, effective communication, and a solid understanding of healthcare regulations. Proficiency with electronic health records (EHR) systems and clinical assessment skills are also important.
Typically, you need a registered nursing (RN) license and may require a bachelor's degree in nursing or a related field. Experience in clinical nursing and certifications in utilization management or case management can enhance your qualifications.
Responsibilities include reviewing patient treatment plans for medical necessity, collaborating with healthcare providers, ensuring compliance with regulations, documenting findings, and recommending appropriate care levels. You'll also communicate with patients and insurance companies as needed.
Benefits include flexible work hours, the ability to work from home, reduced commuting costs, and a better work-life balance. Remote roles also offer the chance to make a significant impact on patient care while enjoying a varied work environment.
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