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 Humana, Toney HealthCare Consulting, and Guidehealth. See the openings below and apply to the ones that match your experience.
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Position: Medical Director of Utilization Management
Location: 120 Broadway New York (Must Reside in NY/NJ/CT)
Work Schedule: Hybrid Full-Time
Compensation: $201,807.75 - $227,033.72 Annual Salary
A little about us
VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years
Job Summary:
The Medical Director for VillageCareMAX is a physician who serves as clinical lead for the Utilization Management Department and medical quality and cost effectiveness activities. The Medical Director assists the VP of Medical Management to direct and coordinate medical management and quality improvement activities for the Health Plan.
Essential Job Functions:
- Responsible for providing oversight to the delivery of utilization management (UM) services and resources, consisting of case reviews for organizational determinations, peer to peer reviews and appeals
- Utilizes the care management system to document all case reviews
- Participates in case rounds/ICT meetings in the development of UM/CM plans for individual members to ensure appropriate continuity of care
- Analyzes utilization patterns, trends, and implements strategies to bring utilization patterns in line with expected benchmarks
- Responsible for successful compliance with regulatory and contractual requirements for Medical Management functions
- Participates in State and Federal Regulatory audits, investigations, surveys, and other reviews by the UM Department
- Maintains current knowledge of Federal and State regulatory requirements
- Develops and proposes annual goals and provides regular reports on progress toward accomplishing those goals
Experience:
- This position requires 3-5 years of health plan experience in medical management with Medicare and Medicaid Programs (specifically MLTC, MAP, DSNP and MAPD)
- Experience with both inpatient and outpatient utilization management (medical, pharmacy)
- Experience with appeal reviews
- NY Market Experience
- No New York Group or Hospital Affiliations
Education and certification:
- Medical Doctorate is required for this position.
- Master's Degree in public health is also preferred
- Certification: Required: Current and unrestricted Physician license to practice in NY
- Preferred: Board Certified, preferably internal medicine or emergency medicine or family medicine
Position: Medical Director of Utilization Management
Location: 120 Broadway New York (Must Reside in NY/NJ/CT)
Work Schedule: Hybrid Full-Time
Compensation: $201,807.75 - $227,033.72 Annual Salary
A little about us
VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years
Job Summary:
The Medical Director for VillageCareMAX is a physician who serves as clinical lead for the Utilization Management Department and medical quality and cost effectiveness activities. The Medical Director assists the VP of Medical Management to direct and coordinate medical management and quality improvement activities for the Health Plan.
Essential Job Functions:
- Responsible for providing oversight to the delivery of utilization management (UM) services and resources, consisting of case reviews for organizational determinations, peer to peer reviews and appeals
- Utilizes the care management system to document all case reviews
- Participates in case rounds/ICT meetings in the development of UM/CM plans for individual members to ensure appropriate continuity of care
- Analyzes utilization patterns, trends, and implements strategies to bring utilization patterns in line with expected benchmarks
- Responsible for successful compliance with regulatory and contractual requirements for Medical Management functions
- Participates in State and Federal Regulatory audits, investigations, surveys, and other reviews by the UM Department
- Maintains current knowledge of Federal and State regulatory requirements
- Develops and proposes annual goals and provides regular reports on progress toward accomplishing those goals
Experience:
- This position requires 3-5 years of health plan experience in medical management with Medicare and Medicaid Programs (specifically MLTC, MAP, DSNP and MAPD)
- Experience with both inpatient and outpatient utilization management (medical, pharmacy)
- Experience with appeal reviews
- NY Market Experience
- No New York Group or Hospital Affiliations
Education and certification:
- Medical Doctorate is required for this position.
- Master's Degree in public health is also preferred
- Certification: Required: Current and unrestricted Physician license to practice in NY
- Preferred: Board Certified, preferably internal medicine or emergency medicine or family medicine
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Find JobsRemote Utilization Management Nurse Job Market
Who's Hiring
- Humana12
- Toney HealthCare Consulting3T
- Guidehealth2
- Oscar Health2
- Devoted Health2
Top Industries Hiring
- Insurance
- Technology & Software
- Healthcare & Medical Services
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.
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 Humana, Toney HealthCare Consulting, and Guidehealth, based on current remote listings on Migrate Mate as of November 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 Insurance, Technology & Software, and Healthcare & Medical Services, based on current remote listings on Migrate Mate as of November 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.
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