Remote RN: Utilization Management Reviewer
Sagility
Join our team: Sagility is looking for a Remote RN: Utilization Management Reviewer to join their Remote team. This Full-Time role comes with a competitive package. See below for the full job description and requirements. Posted: Oct 21, 2026. Sagility is hiring an RN Utilization Management Reviewer for a fully remote, home-based role in the United States. You will perform day-to-day clinical and service authorization reviews for medical necessity and ensure compliance with CMS standards. Qualified candidates hold an MA RN license with an Associate's degree, and 1–2 years of UM experience in a clinical setting. CCM is a plus; strong communication and teamwork skills are essential. #J-18808-Ljbffr
$35 - $40 per hour
...service offerings for clinical, case management, member engagement, provider... ...containment, and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct timely clinical... ...may require weekends. Location: Fully remote work at home role. Secure, private...Remote workHourly payTemporary workMonday to FridayFlexible hoursWeekend work- Cook Children's Health Care System is seeking a Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer to coordinate the efficient utilization of health care resources for CCHP members and ensure timely, quality care throughout the continuum...Remote job
- ...That's the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title Utilization Management RN Reviewer Location Cleveland Facility Remote Location Department Utilization And Quality Assur-Weston Hospital Job Code 000446 Shift Days Schedule...Remote workFull timeWork at officeShift workWeekend work
- Coastal Care Services, Inc. is seeking an LPN licensed Utilization Management Nurse Reviewer for a work-from-home opportunity serving the Miami, FL area. Work schedule is 10am to 7pm, with every other Sunday and a weekday off for a total of five days per week. The role...Remote jobWeekday work
- ...Role Overview Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient... ...Ability to obtain additional RN licensure across the enterprise including... ...Package Flexible work solutions include remote options, hybrid work schedules,...Remote workMonday to FridayFlexible hoursWeekend work
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote workFull timeWork from home
$86k - $117.3k
...For roles that are 100% remote or hybrid, you must have access... ...most. We offer integrated managed care products, pharmaceutical... ...of a supervisor, the Utilization Management Reviewer evaluates medical necessity... ...unencumbered Registered Nurse (RN) license in the District of...Remote workHourly payContract workMonday to FridayFlexible hoursWeekend work2 days per week- ...Great Place to Work" company is seeking a Physician to provide utilization review services for the Group Health Department. This role... ...business background required Experience in Utilization Management with criteria review utilizing standard practice guidelines...Remote work
- ...Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role. You will apply UM criteria and clinical judgment to determine coverage for inpatient and outpatient services, coordinating with care teams to ensure appropriate...Remote workFull time
$219k - $286.9k
...Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a... ...weekend every 16 weeks Work Location: This is a remote position, open to candidates who reside in the United...Remote workFull timeLocal areaWork from homeHome officeWeekend work- ...A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote workFull timeCasual workMonday to Friday
- ...Oak Street Health is seeking a Full-Time Utilization Management Physician Reviewer to provide accurate coverage determinations for inpatient and outpatient services, applying UM criteria, clinical judgment, and internal policies. You will coordinate with care teams to...Remote workFull time
- ...Flexible Independent Contractor (1099) Remote Opportunity Required State Medical... ...ABOUT MRIoA Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally... ...) specializing in technology-driven utilization management and clinical medical review solutions....Remote jobFor contractorsFlexible hours
- Location Remote - TX Department Utilization Shift First Shift (United States of America) Standard Weekly... ...members. Works with the Department Manager and Team Lead to assure the timely... ...Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate...Remote workShift workDay shift
$230k
...Utilization Management Physician Reviewer We're building a world of health around every individual — shaping a more connected, convenient and compassionate... ...time. Company: Oak Street Health Location: Fully Remote Hours: Full-Time, Monday - Friday, 8am -5pm CST...Remote workFull timeMonday to Friday- Oscar Health seeks a Physician Reviewer to join the Utilization Management team in a remote US-based role. You will determine the medical appropriateness of services and document decisions using evidence-based guidelines and Oscar workflows. Responsibilities include timely...Remote job
- ...States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient... ...planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and... ...management to ensure timely reviews, document outcomes, and maintain...Remote workFull time
- ...seeking a Pre-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests, determine... ...appropriate care settings, and educate providers on utilization and management processes. Requirements include an active...Remote workFull time
- ...Humana is seeking an Utilization Management Registered Nurse to interpret and... ...post-acute care. You will work remotely, reporting to the Manager of... ...include an active RN license in your state and 1+... ...candidates have UM/utilization review experience, knowledge of Milliman...Remote work
- ...Cambia Health Solutions, Inc. is seeking a Utilization Management Nurse to join our Clinical Services team. This remote role supports members in Oregon, Washington, Idaho... ...prospective, concurrent and retrospective reviews to ensure medical necessity and promote cost-...Remote work
- ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00 PM... ...brings proven experience conducting utilization reviews within a SNF, health plan, or managed care...Remote workFull timeMonday to Friday
- ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges. Qualifications include RN...Remote work
- ...A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare...Remote workContract work
$59.5k - $116.6k
...UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote workWeekend work- ...Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and document findings for determinations... ...ensuring timely decisions in a remote work environment. Ideal candidates hold an active IL RN license, have 3+ years in...Remote work
- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
- ...Utilization Management RN (Part-Time, Remote) Position Overview Under the direction of a designated manager, the Utilization Management RN performs telephonic review of hospital admissions and recommends alternative levels of care when appropriate. This role...Remote workPart timeMonday to Friday
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote ~ Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare... ...Nurseis responsible for performing utilization review activities in compliance with federal and state regulations...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- ...CVS Health Corporation is seeking a Remote UM Nurse Consultant RN Precertification for Telework. This role involves reviewing clinical information, collaborating with... ...high-volume, computer-based setting and support utilization management from home. #J-18808-Ljbffr...Remote workFull time
- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant (RN) to remotely review authorizations and assess medical necessity across multiple specialties. You will collaborate with care teams to ensure compliant, evidence-based reviews and timely decisions...Remote work
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