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Utilization review (UR) nurses, also called utilization management (UM) nurses, decide whether requested care meets medical-necessity criteria: an inpatient admission, another day in the hospital, a skilled nursing stay, a procedure or a prescription. They work for health plans, review companies and claims administrators, and the work is almost entirely chart review, which is why it is one of the most common fully remote nursing jobs.
Every listing above is fully remote and was checked against the employer's own careers page. Titles vary: utilization management nurse, concurrent review nurse, clinical review nurse, medical management nurse and appeals nurse are all versions of the same job.
What a utilization review nurse does
- Prospective review (prior authorization): checking a request before the service happens.
- Concurrent review: following a hospital or post-acute stay and deciding whether each additional day is still needed.
- Retrospective review and appeals: looking at care after the fact, or reconsidering a request that was not approved.
- Applying criteria such as InterQual and MCG, the commercial medical-necessity guidelines used by health plans and hospitals.
- Escalating cases that don't clearly meet criteria to a physician reviewer instead of deciding them alone.
- Documenting each decision within the plan's turnaround deadlines.
How much do remote utilization review nurses make?
Across the 12 utilization review listings on JobSnag in October 2026, the midpoint of the posted pay range was about $38 an hour, roughly $79,000 a year. Posted ranges ran from $22 an hour for LPN reviewers to $63 an hour at the top of one health plan's RN band, and 5 of the 12 listings did not post pay at all.
Expect LPN reviewer roles at the low end and lead or senior RN reviewer roles at the top. For a national baseline, the Bureau of Labor Statistics puts the median for all registered nurses at $97,550 a year and for LPNs and LVNs at $64,400, as of May 2025 (BLS).
What employers ask for
- Acute care experience. Hospital experience comes up often, because you are judging inpatient care.
- Criteria experience. Several listings ask for InterQual or MCG directly. If you used them as a hospital case manager, put it on your resume.
- Coding familiarity. Some listings mention ICD-10 and CPT codes.
- The right license for the right states. Most RN listings here name the states they accept rather than requiring a compact license, so read the license line on each job. The compact license section of the remote nursing hub explains the rules.
- LPNs: four listings here are open to LPNs or LVNs, mostly first-level review, PRN review and appeals support. See all remote LPN jobs.
Employers hiring remote utilization review nurses
Current listings come from health plans (CVS Health, Humana, Elevance Health, Centene, Clover Health), utilization review and clinical-intelligence companies (Cohere Health, Xsolis, Dane Street), the claims administrators Sedgwick and WPS Health Solutions, and Personify Health. Every Apply button leads to the employer's own site.
Utilization review or case management?
Utilization review is chart-focused: you decide whether care meets criteria and rarely talk to patients. Remote nurse case managers do the opposite, coaching patients by phone over weeks or months. Hospital case management experience counts toward both, so nurses often move between them.
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Remote Utilization Review Nurse Jobs — FAQ
Is utilization review nursing hard to get into?
It is not an entry-level job. Most listings ask for several years of clinical nursing, and acute care or prior utilization review experience is a common preference. If you have used InterQual or MCG as a hospital case manager, that experience carries over directly.
Can an LPN be a utilization review nurse?
Yes. Four of the listings on this page accept LPN or LVN licenses, mostly for first-level review, PRN review and appeals support. RN roles cover more complex reviews and lead positions.
How much do remote utilization review nurses make?
On JobSnag's utilization review listings in October 2026, the midpoint of the posted range was about $38 an hour, or roughly $79,000 a year. LPN reviewer roles sit at the low end and lead RN roles at the top.
Do utilization review nurses deny care?
Generally no. Nurses apply criteria and can approve requests that clearly meet them; cases that do not are sent to a physician reviewer, who makes the medical-necessity decision.