Remote Utilization Management Nurse Jobs
Remote Utilization Management Nurse jobs are in steady demand across the U.S., with remote-first insurers, managed care organizations, and distributed health plan teams actively hiring nurses who can conduct clinical reviews, manage authorization workflows, and communicate decisions asynchronously. Employers hiring remotely right now include CVS Health, Oscar Health, and Cambia Health Solutions. See the openings below and apply to the ones that match your experience.
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Showing 5 of 36+ Remote Utilization Management Nurse jobs
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Utilization Management Nurse Consultant Clinical Precertification RN (Medicare)
Remote | Full-Time | Weekday Schedule
Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time.
What You’ll Do
- Review clinical cases and make coverage determinations using evidence-based guidelines
- Collaborate with providers and care teams to coordinate appropriate treatment
- Apply clinical judgment to support utilization and benefit management decisions
- Identify opportunities to improve care quality and member outcomes
- Serve as a clinical resource across internal and external stakeholders
What You Bring - REQUIRED
- Active, unrestricted RN license in the state of residence.
- 3+ years of RN experience, including 1+ year in Med/Surg
- Strong clinical assessment and decision-making skills
- Experience with Microsoft Office (Outlook, Teams, Excel)
- Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
- Associate Degree in Nursing
Nice to Have
- Utilization Management or Prior Authorization experience
- Managed care background
- Familiarity with MedCompass
- Ambulatory surgery experience
- BSN preferred
Why Join Us?
- Transition your clinical skills into a collaborative, non-bedside role
- Make a meaningful impact on patient care and outcomes
- Work in a supportive, team-driven environment
If you’re passionate about combining clinical expertise with care coordination and healthcare quality, we’d love to hear from you!
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$29.10 - $62.32
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 07/04/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Utilization Management Nurse Consultant Clinical Precertification RN (Medicare)
Remote | Full-Time | Weekday Schedule
Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time.
What You’ll Do
- Review clinical cases and make coverage determinations using evidence-based guidelines
- Collaborate with providers and care teams to coordinate appropriate treatment
- Apply clinical judgment to support utilization and benefit management decisions
- Identify opportunities to improve care quality and member outcomes
- Serve as a clinical resource across internal and external stakeholders
What You Bring - REQUIRED
- Active, unrestricted RN license in the state of residence.
- 3+ years of RN experience, including 1+ year in Med/Surg
- Strong clinical assessment and decision-making skills
- Experience with Microsoft Office (Outlook, Teams, Excel)
- Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
- Associate Degree in Nursing
Nice to Have
- Utilization Management or Prior Authorization experience
- Managed care background
- Familiarity with MedCompass
- Ambulatory surgery experience
- BSN preferred
Why Join Us?
- Transition your clinical skills into a collaborative, non-bedside role
- Make a meaningful impact on patient care and outcomes
- Work in a supportive, team-driven environment
If you’re passionate about combining clinical expertise with care coordination and healthcare quality, we’d love to hear from you!
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$29.10 - $62.32
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 07/04/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
See All 36 Remote Utilization Management Nurse Jobs
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Find JobsRemote Utilization Management Nurse Job Market
Who's Hiring
- CVS Health3
- Oscar Health3
- Cambia Health Solutions3
- Optum2
- Alignment Healthcare2
Top Industries Hiring
- Healthcare & Medical Services17
- Insurance12
- Technology & Software2
- Government & Public Sector1
- Non-Profit & Social Services1
What Employers Look For
The qualifications that appear most often in remote utilization management nurse jobs.
- Active registered nurse license in the state of hire or compact licensure
- Minimum two to three years of acute care or direct clinical nursing experience
- Working knowledge of InterQual or Milliman Care Guidelines criteria
- Experience with prior authorization, concurrent review, or discharge planning
- Familiarity with ICD-10 coding and medical necessity documentation standards
- Proficiency with electronic health records and utilization management software platforms
Tips for Your Remote Utilization Management Nurse Job Search
Prove your async clinical documentation skills
Remote UM employers evaluate written communication before the interview. Pull two or three examples of clinical review notes or authorization rationales you've written and be ready to describe them specifically. Clear, concise written documentation is the core deliverable in a remote UM role.
Highlight criteria knowledge in your application
Call out your InterQual, MCG, or Milliman experience by name in your resume and cover letter. Remote hiring managers use clinical criteria platforms daily and filter for nurses who can apply them independently without in-person training or supervision from day one.
Apply early to remote roles that fit
Migrate Mate lists remote utilization management nurse openings from across the U.S. in one place so you can find roles that match your clinical background and apply directly. Applying within the first few days of a posting going live improves your chances before the shortlist fills.
Prepare for technology-focused screening calls
Remote UM employers often open interviews by asking how you've navigated EHR systems, authorization portals, and video conferencing in past roles. Name the specific platforms you've used, such as Epic, Facets, or Zoom, and describe how you managed your daily case queue without on-site support.
Frame your self-management approach concretely
Remote UM teams want nurses who manage caseloads, deadlines, and physician callbacks without prompting. In interviews, describe your actual system for prioritizing concurrent reviews and tracking turnaround time requirements, because independent workflow management is what remote employers are hiring for.
Remote Utilization Management Nurse Jobs: Frequently Asked Questions
How do I get a remote utilization management nurse job?
Target employers that have already built distributed clinical review teams, such as remote-first health plans, managed care organizations, and third-party administrators, because they have established workflows for remote nurses. Remote hiring managers screen heavily for self-direction, clear written clinical documentation, and comfort with utilization management platforms like InterQual or MCG. Candidates who can describe specific prior auth or concurrent review experience and show they communicate findings precisely in writing move to the top of the shortlist.
Which companies hire remote utilization management nurses?
Companies hiring remote utilization management nurses right now include CVS Health, Oscar Health, and Cambia Health Solutions, based on current remote listings on Migrate Mate as of June 2026. Remote openings for this role concentrate at health insurers, managed care organizations, and third-party clinical review firms that operate distributed nursing teams.
Can you get a remote utilization management nurse job with no experience?
Yes, but entry-level remote utilization management nurse roles are harder to land because you must work independently from day one without on-site clinical supervision. Remote-first third-party review firms and smaller managed care companies are more open to newer UM nurses than large legacy insurers. Showing familiarity with InterQual or MCG guidelines, strong written clinical documentation from bedside or case management work, and comfort with async communication tools helps close the experience gap.
Do you need a degree for remote utilization management nurse jobs?
Usually, but the requirement is an active RN license rather than a specific degree level, and many remote employers weigh direct clinical experience and documentation skills as heavily as your academic background. Nurses with ADN credentials who have strong case management, prior authorization, or discharge planning backgrounds are regularly hired into remote UM roles. What remote employers prioritize is your ability to apply clinical criteria independently and communicate decisions clearly in writing.
Which industries hire the most remote utilization management nurses?
Remote utilization management nurse roles concentrate in Healthcare & Medical Services, Insurance, and Technology & Software, based on current remote listings on Migrate Mate as of June 2026. Those sectors hire remote utilization management nurses because their clinical review and authorization workflows can be performed entirely through electronic health records, phone-based peer-to-peer reviews, and distributed case management platforms.
See All 36 Remote Utilization Management Nurse Jobs
Find roles that match your experience and apply in just a few clicks.
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