Remote Utilization Review Manager Jobs
Remote Utilization Review Manager jobs are open across the U.S. in health insurance, managed care, and behavioral health, at remote-first payers, third-party administrators, and utilization management firms hiring at both experienced and senior levels. Employers hiring remotely right now include Brundage Medical, Centene, and Personify Health. Scan the live roles below and apply to whichever ones fit.
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Showing 5 of 23+ Remote Utilization Review Manager 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.
Position Summary
This role is work from home with the following hours: 4 ten hour shifts in EST, with rotating days off, rotating on-call weekends and holidays
Applicants must be a RN with a compact licensure required with ability to obtain additional licenses as needed.
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
- Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
- Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
- Identifies members who may benefit from care management programs and facilitates referral
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Required Qualifications
- 3+ years of clinical practice experience in an inpatient setting required
- RN with unrestricted state licensure required
- Willingness to obtain additional state licenses
- Ability to work rotating weekends
Preferred Qualifications
- Managed care/utilization review experience
- Acute care/critical care experience Discharge planning experience
Education
AA Nursing Required
BSN Preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$26.01 - $74.78This 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: 11/19/2026
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.
Position Summary
This role is work from home with the following hours: 4 ten hour shifts in EST, with rotating days off, rotating on-call weekends and holidays
Applicants must be a RN with a compact licensure required with ability to obtain additional licenses as needed.
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
- Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
- Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
- Identifies members who may benefit from care management programs and facilitates referral
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Required Qualifications
- 3+ years of clinical practice experience in an inpatient setting required
- RN with unrestricted state licensure required
- Willingness to obtain additional state licenses
- Ability to work rotating weekends
Preferred Qualifications
- Managed care/utilization review experience
- Acute care/critical care experience Discharge planning experience
Education
AA Nursing Required
BSN Preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$26.01 - $74.78This 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: 11/19/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
See All 23 Remote Utilization Review Manager Jobs
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Find JobsRemote Utilization Review Manager Job Market
Who's Hiring
Top Industries Hiring
- Insurance
- Human Resources
- Technology & Software
What Employers Look For
The qualifications that appear most often in remote utilization review manager jobs.
- Active registered nurse (RN) or other clinical license required
- Two or more years of utilization review or case management experience
- Working knowledge of InterQual or Milliman clinical criteria
- Familiarity with Medicare, Medicaid, and commercial payer guidelines
- Experience managing or supervising a clinical review team
- Proficiency with care management platforms or utilization management software
Tips for Your Remote Utilization Review Manager Job Search
Apply early to remote roles that fit
Migrate Mate lists remote utilization review manager openings from across the U.S. in one place, so you can find roles that match your clinical background and apply directly without sorting through non-remote listings.
Show your async documentation standards
Remote utilization review managers communicate decisions almost entirely in writing. Include specific examples of denial letters, peer-to-peer summaries, or case notes you've written to demonstrate you can convey clinical rationale clearly without real-time back-and-forth.
Demonstrate proficiency with UR platforms
Name the case management and utilization management tools you've used, such as Jiva, Milliman Care Guidelines, or InterQual Connect, in your resume and cover letter. Remote employers shortlist candidates who can operate these systems without an in-office IT team nearby.
Prepare for remote panel interviews on turnaround time
Remote UR manager interviews consistently probe how you meet state and federal turnaround deadlines without direct supervisor access. Walk through a real example where you managed a high-volume queue or escalated a case appropriately while working independently.
Remote Utilization Review Manager Jobs: Frequently Asked Questions
How do I get a remote utilization review manager job?
Remote utilization review manager roles go to candidates who can demonstrate strong clinical judgment, independent decision-making, and clear written communication without in-person oversight. Remote employers screen heavily for familiarity with InterQual or MCG criteria, experience with case management platforms, and the ability to meet turnaround deadlines without direct supervision. Highlighting async documentation skills and prior remote or distributed team experience gives you a real edge.
Which companies hire remote utilization review managers?
Companies hiring remote utilization review managers right now include Brundage Medical, Centene, and Personify Health, based on current remote listings on Migrate Mate as of November 2026. Remote openings for this role are most common at managed care organizations, national health insurers, and third-party utilization management firms that operate distributed clinical teams.
Can you get a remote utilization review manager job with no experience?
Yes, but remote entry-level utilization review roles are harder to land because employers expect you to apply clinical criteria and manage caseloads independently from day one. Your best path in is prior bedside or case management experience that shows clinical judgment, alongside any exposure to utilization review criteria sets like InterQual. Remote-first utilization management vendors are more likely than large payers to hire candidates making the transition.
Do you need a degree for remote utilization review manager jobs?
Usually, but the specific requirement varies by employer. Most remote utilization review manager roles require an active RN license, and some accept other clinical licensure such as LCSW or LPC for behavioral health UR. A bachelor's degree strengthens your candidacy, especially for manager-level positions, but demonstrated clinical experience and familiarity with utilization management criteria often carry more weight than the degree alone.
Which industries hire the most remote utilization review managers?
Remote utilization review manager roles concentrate in Insurance, Human Resources, and Technology & Software, based on current remote listings on Migrate Mate as of November 2026. These sectors rely on distributed clinical teams to handle prior authorization, concurrent review, and appeals across geographically dispersed member populations.
See All 23 Remote Utilization Review Manager Jobs
Find roles that match your experience and apply in just a few clicks.
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