UM Outpatient Review Nurse
All Care To You · United States · US
Utilization Review
Remote
physician
Nurse
Dentist
Demand82
Career growth68
Healthcare fit86
Remote potential95
Salary band
USD 70k – 120k
5-year outlook
Stable managed-care utilization review demand likely persists as payers, IPAs, and TPAs seek cost containment. Compensation should remain competitive for RN reviewers, with advancement into lead reviewer, audit, quality, or case management leadership rather than explosive growth.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-24
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse, Dentist
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth applying for nurses who want a fully remote, non-bedside managed-care role and can tolerate production metrics. Less suitable if you want direct patient care or dislike high-volume authorization work.
Who should apply
RNs with acute care, outpatient, case management, or managed care experience; nurses seeking remote utilization review and comfortable applying CMS/health plan criteria.
CV angle
Frame bedside or outpatient RN experience as evidence of clinical assessment, documentation, interdisciplinary communication, and guideline application. Add any prior authorization, case management, quality, insurance, Medicare/CMS, or utilization review exposure, and quantify caseload, TAT, or accuracy metrics only where real.
Skills to highlight
- Utilization review
- Medical necessity determination
- Prior authorization
- CMS and health plan criteria
- Clinical documentation
- Denial letter writing
- Case management
- TAT/quality metrics
Role summary
Remote RN utilization review role reviewing outpatient authorization and retrospective requests against CMS and health plan criteria, approving cases that meet criteria, referring complex cases to the Medical Director, and writing denial letters while meeting productivity and quality targets.
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