Utilization Review Nurse - Remote - Contract
HireOps Staffing · United States · US
Utilization Review
Remote
physician
Nurse
Demand78
Career growth62
Healthcare fit84
Remote potential100
5-year outlook
Contract utilization review nursing can offer competitive hourly pay, but income stability depends on contract renewals and agency placement. Full-time managed care or payer UR roles may provide more predictable benefits and longer-term advancement.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
–
Date found
2026-10-25
Intelligence details
Flexible work details
- Side income
- Classified as side-income friendly
- Engagement type
- Contract
- Hours
- Variable hours
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse
- Rate period
- Hourly
Why this was classified this way
- Contract
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 considering for RNs with 3+ years of clinical experience who want remote, non-bedside work and are comfortable applying criteria to claims. The contract nature and staffing-agency setup mean you should clarify benefits, renewal likelihood, and conversion potential before applying.
Who should apply
RNs with at least 3 years of clinical experience who are interested in managed care, insurance, or utilization review and want a remote contract role. Nurses with prior payer, claims, case management, or MCG exposure may be especially competitive.
CV angle
Frame bedside RN experience around clinical assessment, documentation review, treatment-plan evaluation, provider communication, and application of evidence-based criteria. Highlight any exposure to insurance, managed care, claims, MCG, quality, case management, or regulatory/accreditation standards such as URAC or NCQA without overstating experience.
Skills to highlight
- Medical necessity review
- Clinical assessment and documentation review
- Managed care and insurance knowledge
- MCG criteria and medical policy navigation
- Provider and member communication
- Claims review and medical determination writing
- URAC/NCQA standards awareness
- Organization and prioritization
Role summary
A remote contract utilization review RN role focused on reviewing suspended claims for medical necessity, contract interpretation, and pricing using MCG and medical policies. The nurse communicates determinations to providers or members and applies managed care, accreditation, and claims-process knowledge.
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