Remote Utilization Management Specialist Jobs
Remote Utilization Management Specialist jobs are in active demand across the U.S., with remote-first insurers, managed care organizations, and distributed health plan teams posting openings regularly. Employers hiring remotely right now include CVS Health, Humana, and Toney HealthCare Consulting. Scan the live roles below and apply to whichever ones fit.
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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 Utilization Management Specialist 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 utilization management specialist jobs.
- Active RN, LPN, or clinical licensure required by most employers
- Experience applying InterQual or Milliman medical necessity criteria
- Prior authorization or utilization review experience in a managed care setting
- Proficiency with electronic health records and payer-specific care management platforms
- Knowledge of Medicare, Medicaid, and commercial insurance coverage guidelines
- Certified Case Manager (CCM) or equivalent credential preferred or required
Tips for Your Remote Utilization Management Specialist Job Search
Apply early to remote roles that fit
Migrate Mate lists remote utilization management specialist openings from across the U.S. in one place, so you can find roles that match your license, criteria experience, and caseload background and apply directly before postings fill.
Highlight async clinical communication skills
Remote utilization management work runs on written rationale, not hallway conversations. Show employers you write clear, defensible medical necessity determinations by referencing documentation examples and your fluency with electronic health record notes and secure messaging platforms.
Demonstrate independent caseload management
Remote hiring managers want to see that you can prioritize and close authorizations without a supervisor nearby. Quantify how many cases you managed per day or week in prior roles and describe how you tracked pending reviews and met turnaround time requirements on your own.
Match your criteria knowledge to the posting
Remote utilization management roles specify InterQual, MCG, or proprietary payer guidelines. Read each posting carefully and name the exact criteria set you've used in your application materials, because remote teams rarely have time to train on criteria from scratch.
Remote Utilization Management Specialist Jobs: Frequently Asked Questions
How do I get a remote utilization management specialist job?
Remote utilization management specialist roles go to candidates who can demonstrate clinical judgment, organized documentation habits, and the ability to manage caseloads without in-person supervision. Managed care companies and third-party administrators hiring remotely screen heavily for written communication skills, experience with InterQual or MCG criteria, and comfort with electronic health record platforms. Showing concrete examples of independent decision-making and clear written rationale in prior roles gives you a real edge.
Which companies hire remote utilization management specialists?
Remote utilization management specialist roles are posted by CVS Health, Humana, and Toney HealthCare Consulting and others right now, based on current remote listings on Migrate Mate as of November 2026. The bulk of remote postings come from health insurance carriers, managed care organizations, and third-party utilization review firms that run fully distributed clinical teams.
Can you get a remote utilization management specialist job with no experience?
Yes, but remote entry-level roles in utilization management are harder to land because you must work independently from day one with minimal hands-on mentorship. Smaller third-party review companies and telehealth-adjacent firms are more likely to consider candidates new to UM if you have a clinical background, such as nursing or allied health, and can demonstrate familiarity with medical necessity criteria and documentation standards.
Do you need a degree for remote utilization management specialist jobs?
Usually, but the degree requirement is clinical rather than academic in the traditional sense. Most remote employers require an active clinical license, such as an RN, LVN, or LPN credential, or a health-related bachelor's degree. Remote hiring managers weigh hands-on clinical experience, knowledge of payer guidelines, and demonstrated documentation skills as heavily as formal education credentials.
Which industries hire the most remote utilization management specialists?
The sectors hiring the most remote utilization management specialists are Insurance, Technology & Software, and Healthcare & Medical Services, based on current remote listings on Migrate Mate as of November 2026. These sectors rely on distributed clinical teams to review authorizations, manage care coordination workflows, and process medical necessity determinations across multiple time zones without a central office.
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