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 Centene, Brundage Medical, and Cobalt Benefits Group. See the openings below and apply to the ones that match your experience.
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Showing 5 of 33+ Remote Utilization Review Nurse jobs
- Perform quality utilization review through the use of acquired knowledge and application of evidenced based guidelines for peer review reports, correspondences, addendums and/or supplemental reviews.
- Work directly with providers to identify level, intensity and duration of care.
- Document findings, continue to evaluate medical necessity for frequency, intensity and length of required care.
- Assure that the consistency and quality of reviews meets or exceeds industry standards.
- Work to ensure quality reviews are completed within the required client, federal and state or URAC mandated turnaround times.
- Maintain and apply knowledge of URAC and other state and federal regulatory requirements.
- Maintain accurate record of Utilization Reviews within the appropriate database.
- Direct Customer Service Representatives to ensure timely delivery of determination letters.
- Assist in resolution of client complaints and/or quality assurance issues as needed.
- Ensure all quality assurance standards and federal ERISA, URAC, and/or other state guidelines are adhered to at all times.
- Provide insight and direction to management on any compliance concerns regarding products, company policies and procedures and/or client specifications.
- Participate in company meetings, training activities and continuing education requirements.
- Perform all other duties as assigned.
- High school diploma or equivalent required.
- Must be a graduate of an accredited nursing program; bachelor’s degree preferred.
- Minimum of three to five years of direct professional patient care required.
- Experience in utilization management preferred.
- Active unencumbered Registered Nurse, Licensed Practical Nurse or Licensed Vocational Nurse required.
- Must have strong knowledge of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values.
- Must be a qualified typist with a minimum of 40 W.P.M.
- Must be able to operate a general computer, fax, copier, scanner, and telephone.
- Must be knowledgeable of multiple software programs, including but not limited to Microsoft Suite.
- Ability to follow instructions and respond to upper managements’ directions accurately.
- Must demonstrate accuracy, thoroughness, and responsibility for quality of work, and ability to take initiative to identify improvements. Look for ways to improve and promote quality and monitors own work to ensure quality is met.
- Must be able to work independently, prioritize work activities and use time efficiently.
- Must be able to maintain confidentiality.
- Must be able to demonstrate and promote a positive team -oriented environment.
- Must be able to stay focused and concentrate with frequent interruptions and be able to work well under pressure and or stressful conditions.
- Must possess the ability to manage change, delays, or unexpected events appropriately.
- Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.
- Perform quality utilization review through the use of acquired knowledge and application of evidenced based guidelines for peer review reports, correspondences, addendums and/or supplemental reviews.
- Work directly with providers to identify level, intensity and duration of care.
- Document findings, continue to evaluate medical necessity for frequency, intensity and length of required care.
- Assure that the consistency and quality of reviews meets or exceeds industry standards.
- Work to ensure quality reviews are completed within the required client, federal and state or URAC mandated turnaround times.
- Maintain and apply knowledge of URAC and other state and federal regulatory requirements.
- Maintain accurate record of Utilization Reviews within the appropriate database.
- Direct Customer Service Representatives to ensure timely delivery of determination letters.
- Assist in resolution of client complaints and/or quality assurance issues as needed.
- Ensure all quality assurance standards and federal ERISA, URAC, and/or other state guidelines are adhered to at all times.
- Provide insight and direction to management on any compliance concerns regarding products, company policies and procedures and/or client specifications.
- Participate in company meetings, training activities and continuing education requirements.
- Perform all other duties as assigned.
- High school diploma or equivalent required.
- Must be a graduate of an accredited nursing program; bachelor’s degree preferred.
- Minimum of three to five years of direct professional patient care required.
- Experience in utilization management preferred.
- Active unencumbered Registered Nurse, Licensed Practical Nurse or Licensed Vocational Nurse required.
- Must have strong knowledge of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values.
- Must be a qualified typist with a minimum of 40 W.P.M.
- Must be able to operate a general computer, fax, copier, scanner, and telephone.
- Must be knowledgeable of multiple software programs, including but not limited to Microsoft Suite.
- Ability to follow instructions and respond to upper managements’ directions accurately.
- Must demonstrate accuracy, thoroughness, and responsibility for quality of work, and ability to take initiative to identify improvements. Look for ways to improve and promote quality and monitors own work to ensure quality is met.
- Must be able to work independently, prioritize work activities and use time efficiently.
- Must be able to maintain confidentiality.
- Must be able to demonstrate and promote a positive team -oriented environment.
- Must be able to stay focused and concentrate with frequent interruptions and be able to work well under pressure and or stressful conditions.
- Must possess the ability to manage change, delays, or unexpected events appropriately.
- Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.
See All 33 Remote Utilization Review Nurse Jobs
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Find JobsRemote Utilization Review Nurse Job Market
Who's Hiring
Top Industries Hiring
- Insurance
- Technology & Software
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 Centene, Brundage Medical, and Cobalt Benefits Group and others right now, based on current remote listings on Migrate Mate as of September 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 Technology & Software, per current remote listings on Migrate Mate as of September 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.
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