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, Guidehealth, and CommunityCare. Scan the live roles below and apply to whichever ones fit.
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Showing 5 of 96+ Remote Utilization Management Specialist 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 Specialist 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 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, Guidehealth, and CommunityCare and others right now, based on current remote listings on Migrate Mate as of September 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 September 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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