Remote Utilization Review Nurse Jobs
Remote Utilization Review Nurse jobs are open across the U.S. at health plans, managed care organizations, and utilization management firms hiring on distributed teams. Remote-first employers in insurance, telehealth, and third-party administration are actively filling these roles, including Personify Health, Oscar Health, and Medical Review Institute of America. See the openings below and apply to the ones that match your experience.
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Showing 4 of 23+ Remote Utilization Review Nurse jobs
Primary City/State:
Virtual - ArizonaCategory:
Case ManagementShift:
DayDepartment:
Case Management- 7:30 -4:00
- Team Operates Monday through Sunday
- Remote After Training
Great care starts with great people. (Like you.)
At HonorHealth, you’ll find something special. From humble beginnings in 1927 to one of Arizona’s largest nonprofit healthcare systems, our culture is built on warmth and neighborly kindness. Behind every smile is a highly skilled professional with deep expertise and an unwavering dedication to what matters most — caring for the health and well-being of people and communities across the greater Phoenix area.
Responsibilities:
Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care services with the goal of maintaining high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical necessity reviews for all Medicare, AHCCCS, Self-pay, and all other payers, upon admission and concurrently throughout the admission.
Essential Functions
- Reviews clinical documentation and facilitates modifications (as needed) to ensure that documentation accurately reflects the level of service rendered and severity of illness (in compliance with government and other regulations) for all patients. Performs initial and concurrent reviews on all patients entering the health care continuum.
- Facilitates the delivery of services to patients and families through effective utilization of available resources. Performs medical record reviews, as required by payer. Interfaces with Care Management team to provide information regarding quality outcome measurements (such as timeliness and appropriateness of services). Collaborates with physicians, case managers, payers and others to appeal individual denials and trended issues related to contract guidelines. Works with medical records, finance and physician groups to develop systems to facilitate complete documentation for data reporting purposes.
- Initiates chart reviews, conducts follow-up reviews, and rounds on patients to ensure continuity of UR reviews.
- Maintains a system to identify admissions with specific diagnosis / DRG classifications or other categories of admissions. Notifies attending physicians and house staff or other appropriate staff of documentation issues requiring clarification.
- Determines qualifications for hospital level of care based on set criteria.
- Performs other duties as assigned.
- Bachelor's Degree in Nursing from an accredited NLN/CCNE institution - Preferred
- Associate's Degree in Nursing from an accredited NLN/CCNE institution - Required
- 1 year experience in UR/UM or Case Management - Required
- 3 years Registered Nurse in an acute care setting. - Required
- Registered Nurse (RN) State And/Or Compact State Licensure - Required
- Certified Case Management (ACM) Case Management Certification - Preferred
We're all in for your career.
Primary City/State:
Virtual - ArizonaCategory:
Case ManagementShift:
DayDepartment:
Case Management- 7:30 -4:00
- Team Operates Monday through Sunday
- Remote After Training
Great care starts with great people. (Like you.)
At HonorHealth, you’ll find something special. From humble beginnings in 1927 to one of Arizona’s largest nonprofit healthcare systems, our culture is built on warmth and neighborly kindness. Behind every smile is a highly skilled professional with deep expertise and an unwavering dedication to what matters most — caring for the health and well-being of people and communities across the greater Phoenix area.
Responsibilities:
Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care services with the goal of maintaining high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical necessity reviews for all Medicare, AHCCCS, Self-pay, and all other payers, upon admission and concurrently throughout the admission.
Essential Functions
- Reviews clinical documentation and facilitates modifications (as needed) to ensure that documentation accurately reflects the level of service rendered and severity of illness (in compliance with government and other regulations) for all patients. Performs initial and concurrent reviews on all patients entering the health care continuum.
- Facilitates the delivery of services to patients and families through effective utilization of available resources. Performs medical record reviews, as required by payer. Interfaces with Care Management team to provide information regarding quality outcome measurements (such as timeliness and appropriateness of services). Collaborates with physicians, case managers, payers and others to appeal individual denials and trended issues related to contract guidelines. Works with medical records, finance and physician groups to develop systems to facilitate complete documentation for data reporting purposes.
- Initiates chart reviews, conducts follow-up reviews, and rounds on patients to ensure continuity of UR reviews.
- Maintains a system to identify admissions with specific diagnosis / DRG classifications or other categories of admissions. Notifies attending physicians and house staff or other appropriate staff of documentation issues requiring clarification.
- Determines qualifications for hospital level of care based on set criteria.
- Performs other duties as assigned.
- Bachelor's Degree in Nursing from an accredited NLN/CCNE institution - Preferred
- Associate's Degree in Nursing from an accredited NLN/CCNE institution - Required
- 1 year experience in UR/UM or Case Management - Required
- 3 years Registered Nurse in an acute care setting. - Required
- Registered Nurse (RN) State And/Or Compact State Licensure - Required
- Certified Case Management (ACM) Case Management Certification - Preferred
We're all in for your career.
See All 23 Remote Utilization Review Nurse Jobs
Find roles that match your experience and apply in just a few clicks.
Find JobsRemote Utilization Review Nurse Job Market
Who's Hiring
Top Industries Hiring
- Insurance
- Government & Public Sector
What Employers Look For
The qualifications that appear most often in remote utilization review nurse jobs.
- Active registered nurse license with at least two years of acute care clinical experience
- Working knowledge of InterQual or Milliman evidence-based clinical criteria sets
- Experience with prior authorization, concurrent review, or discharge planning processes
- Proficiency with electronic health records and payer portal documentation systems
- Certified Case Manager (CCM) credential or willingness to obtain within a defined timeframe
- Strong written communication skills for denial letters and clinical documentation in compliance with regulatory standards
Tips for Your Remote Utilization Review Nurse Job Search
Apply early to remote roles that fit
Migrate Mate lists remote utilization review nurse openings from across the U.S. in one place, so you can find roles that match your license, specialty, and availability and apply directly without sorting through unrelated postings.
Showcase async clinical documentation skills
Remote utilization review nurses communicate decisions almost entirely in writing. Highlight examples of prior authorization notes, denial letters, or peer-to-peer summaries you've written to show remote employers you can communicate clinical reasoning clearly without real-time back-and-forth.
List your utilization management software experience
Remote employers screen for hands-on familiarity with InterQual, MCG, or Milliman criteria tools and case management platforms. Name every platform you've used in your resume's skills section so automated screening and hiring managers both register your technical readiness immediately.
Prepare for asynchronous remote interviews
Many distributed health plan and managed care teams use recorded video screening before a live interview. Practice explaining a denial rationale or a complex authorization decision concisely on camera, since remote hiring for utilization review nurses often includes a clinical scenario component.
Remote Utilization Review Nurse Jobs: Frequently Asked Questions
How do I get a remote utilization review nurse job?
Target health plans, managed care organizations, and third-party administrators that run distributed clinical operations teams, since those employers have built workflows designed for remote utilization review nurses. Remote hiring managers screen heavily for self-direction, precise written documentation, and comfort with clinical decision-support software. A background in case management or insurance-based nursing, combined with clear examples of independent clinical judgment, gives candidates a strong edge.
Which companies hire remote utilization review nurses?
Remote utilization review nurse roles are posted by Personify Health, Oscar Health, and Medical Review Institute of America and others right now, based on current remote listings on Migrate Mate as of August 2026. These include remote-first health plans, managed care companies, and utilization management firms across the insurance, telehealth, and behavioral health sectors.
Can you get a remote utilization review nurse job with no experience?
Yes, but remote entry-level utilization review nurse roles are harder to land because employers need confidence you can work independently without on-site supervision from day one. Smaller managed care firms and third-party administrators are more open to entry-level remote hires. Demonstrating familiarity with InterQual or MCG criteria, strong written clinical communication, and any prior case management exposure can open the door.
Do you need a degree for remote utilization review nurse jobs?
Usually, but the requirement is an active RN license rather than a specific degree level in most postings. Remote employers weigh clinical experience, comfort with utilization management platforms, and the ability to apply evidence-based criteria independently. An associate degree with substantial acute care or managed care experience often meets remote employer expectations as well as a BSN.
Which industries hire the most remote utilization review nurses?
Most remote utilization review nurse openings sit in Insurance and Government & Public Sector, per current remote listings on Migrate Mate as of August 2026. Those sectors rely on distributed clinical teams to handle authorization reviews, appeals, and medical necessity determinations across multiple states without requiring nurses to be on-site.
See All 23 Remote Utilization Review Nurse Jobs
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