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, Oscar Health, and Cambia Health Solutions. Scan the live roles below and apply to whichever ones fit.
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Showing 5 of 36+ Remote Utilization Management Specialist 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 Specialist Jobs
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Find JobsRemote Utilization Management Specialist 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 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.
Prepare for remote interviews with structured examples
Remote UM interviews often use scenario-based questions to test clinical judgment without being able to observe you in person. Practice walking through a denial rationale or peer-to-peer appeal scenario out loud, using clear and organized language that holds up on a video call.
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, Oscar Health, and Cambia Health Solutions and others right now, based on current remote listings on Migrate Mate as of June 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 Healthcare & Medical Services, Insurance, and Technology & Software, based on current remote listings on Migrate Mate as of June 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.
See All 36 Remote Utilization Management Specialist Jobs
Find roles that match your experience and apply in just a few clicks.
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