Remote Utilization Manager Jobs
Remote Utilization Manager jobs concentrate in health insurance, managed care, and behavioral health, with openings at health plans, third-party administrators, and care management organizations that run fully distributed teams. Employers currently hiring remote utilization managers include MetroPlusHealth, CorVel Corporation, and Providence. Find a role that fits below and apply directly.
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Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Plays a critical role in ensuring that patients receive high-quality care while efficiently utilizing medical resources. Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments, and collaborating with healthcare providers and insurance companies to ensure a seamless care experience and the practicing of financial stewardship and denial prevention. Focuses on maximizing patient outcomes and optimizing resource allocation. Utilizes exceptional clinical knowledge, excellent communication skills, and the ability to thrive in a fast-paced and ever-changing healthcare environment.
Job Requirements:
Education and Work Experience:
- Associate’s Degree in nursing or equivalent combination of education/related experience: Required
- Bachelor's Degree in Nursing (BSN): Preferred
- Five years' acute hospital experience required with preferred experience in critical care areas: Required
- Two years' utilization review experience using the Optum/Inter Qual product within the last 12 months: Required
Licenses/Certifications:
- Registered Nurse (RN) licensure in the state of practice: Required
Essential Functions:
- Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to determine if the patient is in the right acute setting, receiving the right acute services, during the appropriate length of stay.
- Participates in annual Optum/Inter Qual training required. Takes the required annual Optum/Inter Qual Interrater Reliability (IRR) test with a minimum passing score as defined in the yearly departmental goals.
- Meets weekly productivity metrics within 90 days of completing orientation and maintains on a weekly basis as defined in the yearly departmental goals. Meets quality audit metrics within 90 days of completing orientation and maintained on the audit cadence set within the department as defined in the yearly departmental goals.
- Completes all required departmental education assigned with timeliness and accuracy. Follows all departmental workflows in communication variances to the on-site care management teams when appropriate. Reviews and analyzes medical records to assess the necessity and appropriateness of treatments and interventions.
- Collaborates with healthcare professionals to develop and implement comprehensive patient care plans. Facilitates communication between the patient, healthcare team, insurance providers, and other stakeholders to ensure a coordinated and efficient care process. Stays up to date with the latest healthcare regulations, insurance guidelines, and evidence-based practices to ensure the delivery of optimal healthcare services.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Plays a critical role in ensuring that patients receive high-quality care while efficiently utilizing medical resources. Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments, and collaborating with healthcare providers and insurance companies to ensure a seamless care experience and the practicing of financial stewardship and denial prevention. Focuses on maximizing patient outcomes and optimizing resource allocation. Utilizes exceptional clinical knowledge, excellent communication skills, and the ability to thrive in a fast-paced and ever-changing healthcare environment.
Job Requirements:
Education and Work Experience:
- Associate’s Degree in nursing or equivalent combination of education/related experience: Required
- Bachelor's Degree in Nursing (BSN): Preferred
- Five years' acute hospital experience required with preferred experience in critical care areas: Required
- Two years' utilization review experience using the Optum/Inter Qual product within the last 12 months: Required
Licenses/Certifications:
- Registered Nurse (RN) licensure in the state of practice: Required
Essential Functions:
- Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to determine if the patient is in the right acute setting, receiving the right acute services, during the appropriate length of stay.
- Participates in annual Optum/Inter Qual training required. Takes the required annual Optum/Inter Qual Interrater Reliability (IRR) test with a minimum passing score as defined in the yearly departmental goals.
- Meets weekly productivity metrics within 90 days of completing orientation and maintains on a weekly basis as defined in the yearly departmental goals. Meets quality audit metrics within 90 days of completing orientation and maintained on the audit cadence set within the department as defined in the yearly departmental goals.
- Completes all required departmental education assigned with timeliness and accuracy. Follows all departmental workflows in communication variances to the on-site care management teams when appropriate. Reviews and analyzes medical records to assess the necessity and appropriateness of treatments and interventions.
- Collaborates with healthcare professionals to develop and implement comprehensive patient care plans. Facilitates communication between the patient, healthcare team, insurance providers, and other stakeholders to ensure a coordinated and efficient care process. Stays up to date with the latest healthcare regulations, insurance guidelines, and evidence-based practices to ensure the delivery of optimal healthcare services.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
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Find JobsRemote Utilization Manager Job Market
Who's Hiring
Top Industries Hiring
- Technology & Software
What Employers Look For
The qualifications that appear most often in remote utilization manager jobs.
- Active RN, LCSW, or other clinical licensure required by most employers
- Experience applying InterQual or MCG clinical criteria for prior authorizations and concurrent review
- Minimum of three years clinical experience in acute care, managed care, or case management
- Proficiency with electronic health records and payer or hospital utilization management platforms
- Certified Case Manager or CPHM certification preferred by health plan and managed care employers
- Strong working knowledge of Medicare, Medicaid, and commercial payer coverage guidelines
Tips for Your Remote Utilization Manager Job Search
Apply early to remote roles that fit
Migrate Mate lists remote utilization manager openings from across the U.S. in one place, so you can find roles that match your clinical background and apply directly. Remote postings at distributed health plans fill fast, so applying early matters.
Prove your async communication skills upfront
Remote utilization managers document decisions, write denial rationales, and coordinate with physicians entirely in writing. Add concrete examples of written clinical communication to your resume, such as appeal letters or UM determination summaries, to show you can work effectively without verbal back-and-forth.
Highlight your utilization review platform fluency
Remote employers screen for hands-on experience with InterQual, MCG, or Milliman Care Guidelines before scheduling interviews. Name the specific platforms you've used and the authorization types you've managed, whether inpatient, outpatient, or behavioral health, so hiring managers know you won't need a learning curve.
Demonstrate your turnaround time discipline
Remote utilization managers own their authorization queues without a supervisor nearby to flag delays. Quantify your average turnaround times and your compliance with state and federal timelines on your resume so distributed team leads can see you've met those standards independently.
Remote Utilization Manager Jobs: Frequently Asked Questions
How do I get a remote utilization manager job?
Remote utilization manager roles go to candidates who can demonstrate strong clinical judgment and self-direction without on-site oversight. Remote employers screen heavily for written communication skills, proficiency with utilization review platforms like InterQual or MCG, and the ability to manage authorization queues independently. Showing a history of meeting turnaround time standards and working within payer guidelines without daily hand-holding gives you a clear edge.
Which companies hire remote utilization managers?
Employers currently hiring remote utilization managers include MetroPlusHealth, CorVel Corporation, and Providence, per current remote listings on Migrate Mate as of November 2026. The majority are health plans, managed behavioral health organizations, and third-party administrators that have built fully distributed clinical operations teams.
Can you get a remote utilization manager job with no experience?
Yes, but remote entry-level utilization manager roles are harder to land because you must demonstrate you can work independently from day one. Some managed care organizations hire new graduates into remote UR coordinator roles that lead into utilization management. Showing clinical experience, familiarity with InterQual or MCG criteria, and strong documentation habits can open the door when direct UM experience is limited.
Do you need a degree for remote utilization manager jobs?
Not always, but most remote employers require an active clinical license, such as an RN, LCSW, or LPC, which typically implies a degree. Remote hiring managers weigh clinical licensure, hands-on utilization review experience, and demonstrated fluency with payer criteria ahead of a specific degree type. Certifications like CCM or CPHM can strengthen your profile when your educational background is nontraditional.
Which industries hire the most remote utilization managers?
Remote utilization manager roles concentrate in Technology & Software, based on current remote listings on Migrate Mate as of November 2026. These sectors hire remotely because their utilization review workflows, authorization platforms, and case documentation systems are entirely cloud-based, making distributed clinical teams fully functional without a physical office.
See All 7 Remote Utilization Manager Jobs
Find roles that match your experience and apply in just a few clicks.
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