Remote Utilization Review Specialist Jobs
Remote utilization review specialist jobs are in active demand across the U.S., with remote-first firms, distributed managed care organizations, and third-party health plan administrators all hiring on a rolling basis. Employers hiring remotely right now include Brundage Medical, Centene, and Personify Health. Find a role that fits below and apply directly.
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Showing 5 of 23+ Remote Utilization Review Specialist 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 Specialist Jobs
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Find JobsRemote Utilization Review Specialist 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 specialist jobs.
- Active RN, LPN, or other clinical licensure in the state of hire
- Demonstrated experience applying InterQual or Milliman clinical criteria
- Knowledge of medical necessity guidelines and insurance authorization processes
- Minimum two to three years of acute care, managed care, or case management experience
- Proficiency with electronic health records and utilization management software platforms
- Familiarity with CMS, URAC, or NCQA compliance and documentation standards
Tips for Your Remote Utilization Review Specialist Job Search
Show your async clinical documentation habits
Remote employers want reviewers who can communicate case rationale clearly in writing without back-and-forth calls. Include examples in your application materials of written denial notices, peer-to-peer documentation, or authorization summaries you have produced independently.
Find remote openings in one place
Migrate Mate lists remote utilization review specialist openings from across the U.S. in one place, so you can find roles that match your credentials and apply directly without sifting through general job boards that mix remote and on-site listings.
Demonstrate proficiency with remote clinical tools
Name the specific platforms you have used in your resume and cover letter: InterQual, MCG, Jiva, Facets, or the EHR systems your previous employers ran. Remote hiring managers screen for tool familiarity because there is no one to train you in person.
Prepare for remote interviews with scenario questions
Remote utilization review interviews focus heavily on how you apply criteria to real cases. Practice walking through a concurrent review scenario out loud, explaining your clinical rationale and how you would escalate or document a denial, since interviewers cannot observe your on-the-job judgment any other way.
Remote Utilization Review Specialist Jobs: Frequently Asked Questions
How do I get a remote utilization review specialist job?
Remote utilization review specialist roles go to candidates who can demonstrate clinical judgment and regulatory knowledge without in-person oversight. Remote employers screen for strong written communication, familiarity with InterQual or MCG criteria, and the ability to manage case queues independently. Highlighting async documentation habits, home-office setup, and experience with electronic health record systems gives you a clear edge over candidates who have only worked on-site.
Which companies hire remote utilization review specialists?
Companies hiring remote utilization review specialists 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 concentrate at managed care organizations, health insurance carriers, and third-party utilization management firms that run fully distributed clinical operations teams.
Can you get a remote utilization review specialist job with no experience?
Yes, but remote entry-level roles are harder to land because you're expected to work independently from day one with minimal hands-on supervision. Your best path is to build direct clinical experience first, such as bedside nursing or case management, then target smaller remote-first utilization management firms that train new reviewers. Completing InterQual or MCG training on your own also signals readiness to work without an in-office support structure.
Do you need a degree for remote utilization review specialist jobs?
Usually, yes. Most remote employers require at minimum an active RN license or equivalent clinical credential, which itself carries degree requirements. That said, some roles accept licensed practical nurses or licensed clinical social workers alongside registered nurses. What remote employers weigh most heavily is your clinical background, your familiarity with utilization criteria sets, and documented experience making authorization decisions accurately and on time.
Which industries hire the most remote utilization review specialists?
The sectors hiring the most remote utilization review specialists are 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 manage authorization workflows and medical necessity reviews across large member or patient populations without requiring reviewers to report to a central office.
See All 23 Remote Utilization Review Specialist Jobs
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