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, Guidehealth, and CommunityCare. See the openings below and apply to the ones that match your experience.
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Showing 5 of 96+ Remote Utilization Management Nurse jobs
- Chesterfield, Missouri
- Nursing
- Nursing
- PRN
- Part-time
- Remote
- JR271147
Job Description
Find your calling at Mercy!
OverviewUtilization Management for the assigned inpatient Care Management population. This position is designed to facilitate an effective process of the Mercy Care Management model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; assisting with patient throughput; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practice
Position Details:
Qualifications
Education: Graduate of an accredited school of nursing.
Licensure: Current license in the state of residence and/or employment, Minimum Required
Experience: 2-3 years acute care hospital setting, Minimum Required
Other: Must have the ability to work independently and meet deadlines, giving attention to detail and follow up, Minimum Required Excellent time management skills, organizational skills, able to coordinate multiple tasks and prioritize work, Minimum Required Must have a good understanding of medical terminology with the ability to read, discuss and understand patient medical information, Minimum Required Excellent verbal and written communication skills, particularly telephone, Minimum Required Advanced computer skills, Minimum Required Must have ability to interact effectively with a variety of people and situations at all levels of the organization, Minimum Required
Preferred Experience: Care Management or Utilization Review experience,
Preferred Certifications: Case Management or Utilization Review, Preferred
Preferred Other:
Why Mercy?
From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
- Chesterfield, Missouri
- Nursing
- Nursing
- PRN
- Part-time
- Remote
- JR271147
Job Description
Find your calling at Mercy!
OverviewUtilization Management for the assigned inpatient Care Management population. This position is designed to facilitate an effective process of the Mercy Care Management model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; assisting with patient throughput; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practice
Position Details:
Qualifications
Education: Graduate of an accredited school of nursing.
Licensure: Current license in the state of residence and/or employment, Minimum Required
Experience: 2-3 years acute care hospital setting, Minimum Required
Other: Must have the ability to work independently and meet deadlines, giving attention to detail and follow up, Minimum Required Excellent time management skills, organizational skills, able to coordinate multiple tasks and prioritize work, Minimum Required Must have a good understanding of medical terminology with the ability to read, discuss and understand patient medical information, Minimum Required Excellent verbal and written communication skills, particularly telephone, Minimum Required Advanced computer skills, Minimum Required Must have ability to interact effectively with a variety of people and situations at all levels of the organization, Minimum Required
Preferred Experience: Care Management or Utilization Review experience,
Preferred Certifications: Case Management or Utilization Review, Preferred
Preferred Other:
Why Mercy?
From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
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Find JobsRemote Utilization Management Nurse Job Market
Who's Hiring
- CVS Health54
- Guidehealth4
- CommunityCare2
- Cambia Health Solutions2
- Trillium Health Resources2
Top Industries Hiring
- Insurance18
- Technology & Software3
- Healthcare & Medical Services2
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 CVS Health, Guidehealth, and CommunityCare, based on current remote listings on Migrate Mate as of September 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 September 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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