Remote Director of Utilization Management Jobs
Remote Director of Utilization Management jobs are open across the U.S. at managed care organizations, health insurance carriers, and distributed healthcare technology companies hiring fully remote leadership. Employers hiring remotely right now include CVS Health, Toney HealthCare Consulting, and Humana. Find a role that fits below and apply directly.
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Become a part of our caring community
The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Use your skills to make an impact
Required Qualifications
- Degree in Nursing
- Must be licensed Registered Nurse in the State of Indiana or Compaq Nursing License with no disciplinary action
- 3+ years of post-degree clinical experience in direct patient care
- 3+ years of Behavioral Health experience
- Proficient with MS Office, navigating multiple systems and platforms and general technical skills to troubleshoot and resolve within a remote environment.
- Ability to work independently.
Preferred Qualifications
- Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual
- Managed Care, Medicaid or health plan experience
Workstyle: Remote Work at Home
Location: Indiana
Schedule: Monday through Friday 8:00-5:00 PM Eastern Time
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Become a part of our caring community
The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Use your skills to make an impact
Required Qualifications
- Degree in Nursing
- Must be licensed Registered Nurse in the State of Indiana or Compaq Nursing License with no disciplinary action
- 3+ years of post-degree clinical experience in direct patient care
- 3+ years of Behavioral Health experience
- Proficient with MS Office, navigating multiple systems and platforms and general technical skills to troubleshoot and resolve within a remote environment.
- Ability to work independently.
Preferred Qualifications
- Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual
- Managed Care, Medicaid or health plan experience
Workstyle: Remote Work at Home
Location: Indiana
Schedule: Monday through Friday 8:00-5:00 PM Eastern Time
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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Find JobsRemote Director of Utilization Management Job Market
Who's Hiring
Top Industries Hiring
- Insurance
- Technology & Software
- Healthcare & Medical Services
What Employers Look For
The qualifications that appear most often in remote director of utilization management jobs.
- Registered nurse or licensed clinician with an active, unrestricted state license
- Five or more years of utilization management or case management experience in an acute or managed care setting
- Working knowledge of InterQual or MCG clinical decision-support criteria
- Demonstrated experience managing clinical denials, appeals, and peer-to-peer review processes
- Proficiency with care management platforms and electronic health record systems
- CPHM, ACM, or CCM certification preferred by most health system and payer employers
Tips for Your Remote Director of Utilization Management Job Search
Apply early to remote roles that fit
Migrate Mate lists remote director of utilization management openings from across the U.S. in one place, so you can find roles that match your clinical background and apply directly without sorting through unrelated postings.
Show async decision-making in your resume
Remote UM directors make coverage and denial decisions without in-person consultation. Highlight experience using InterQual, Milliman, or MCG criteria independently, and note any experience documenting clinical rationale in writing for peer reviewers, medical directors, or regulators.
Demonstrate remote team leadership concretely
Distributed health plans want proof you can manage utilization review nurses and coordinators across time zones. Call out tools you have used, such as Microsoft Teams, Slack, or UM-specific platforms, and name the size and location spread of teams you have directed.
Prepare for remote interview care scenarios
Remote UM director interviews typically include scenario-based questions about denial rationale, escalation paths, and regulatory compliance under URAC or NCQA standards. Practice walking through a denial decision from initial review to appeal in a structured verbal format, since you will not have a whiteboard.
Remote Director of Utilization Management Jobs: Frequently Asked Questions
How do I get a remote director of utilization management job?
Remote employers hiring for this role screen heavily for self-direction, structured written communication, and clinical judgment you can exercise without in-person oversight. Health plans, managed care organizations, and utilization review firms that run distributed teams look for demonstrated experience leading UM programs across care settings, proficiency with clinical decision-support platforms, and the ability to manage staff and interdepartmental workflows asynchronously. InterQual or Milliman criteria expertise and a clinical license signal readiness for remote work from day one.
Which companies hire remote director of utilization managements?
Employers currently hiring remote director of utilization managements include CVS Health, Toney HealthCare Consulting, and Humana, per current remote listings on Migrate Mate as of November 2026. The majority are managed care organizations, commercial health plans, and healthcare services companies that operate distributed clinical and administrative teams across multiple states.
Can you get a remote director of utilization management job with no experience?
Yes, but director-level remote UM roles are competitive and almost always require prior UM management experience because you must direct clinical staff and enforce utilization criteria with no in-person support. Smaller regional health plans and telehealth-first companies occasionally post remote UM manager roles that can serve as a stepping stone. Demonstrating clinical licensure, familiarity with UM software, and measurable outcomes from prior UM work strengthens a candidate's case significantly.
Do you need a degree for remote director of utilization management jobs?
Usually, yes. Remote employers in this space consistently require a clinical degree, most often a registered nursing license, and many also expect a bachelor's or master's degree in nursing or healthcare administration. What carries equal weight is hands-on experience managing utilization review programs, demonstrated knowledge of regulatory requirements, and results tied to denial rates, turnaround times, or cost-of-care improvements.
Which industries hire the most remote director of utilization managements?
Most remote director of utilization management openings sit in Insurance, Technology & Software, and Healthcare & Medical Services, per current remote listings on Migrate Mate as of November 2026. These sectors hire director of utilization managements remotely because their review and authorization workflows operate through cloud-based clinical platforms that distributed teams can access from anywhere.
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