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Assistant Remote Utilization Review Jobs in Pennsylvania

Prestige

LPN Case Manager

PA · Remote

$75K/yr

... utilization review * Facilitate timely and safe discharge planning * Serve as primary point of ... This is a Remote Position. * Competitive Rate * Medical, Dental, and Vision Insurance * 401K ...

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Assistant Remote Utilization Review information

What is the difference between Assistant Remote Utilization Review vs Utilization Review Nurse?

AspectAssistant Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certification in case management or utilization reviewRegistered Nurse (RN) license, often with additional certifications in case management or utilization review
Work EnvironmentRemote, administrative setting, telehealth or telecommutingRemote or hospital/clinic settings, primarily telehealth or administrative
Employer & IndustryHealth insurance companies, managed care organizations, healthcare providersHospitals, insurance companies, healthcare organizations

Both roles involve reviewing patient cases to determine appropriate care and resource utilization. The Assistant Remote Utilization Review typically supports the process with administrative tasks and basic review, while the Utilization Review Nurse performs more in-depth clinical assessments. Both require nursing credentials and often work remotely within healthcare or insurance industries.

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The most popular types of Remote Utilization Review jobs in Pennsylvania are:

What are popular job titles related to Assistant Remote Utilization Review jobs in Pennsylvania?

For Assistant Remote Utilization Review jobs in Pennsylvania, the most frequently searched job titles are:

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The top searched job categories for Assistant Remote Utilization Review jobs in Pennsylvania are:

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Cities in Pennsylvania with the most Assistant Remote Utilization Review job openings:

Assistant Remote Utilization Review jobs near you
Infographic showing various Assistant Remote Utilization Review job openings in Pennsylvania as of August 2026, with employment types broken down into 83% Full Time, and 17% Part Time. Highlights an 100% Remote job distribution.

Medical Director, Utilization Management

UPMC Health Plan

Pittsburgh, PA • Remote

Full-time

Re-posted 21 days ago

Job description

Purpose:
The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health Plan members. This fully remote role will be responsible for assuring physician commitment and delivery of comprehensive high quality health care to UPMC Health Plan members. Oversees adherence to quality and utilization standards through committee delegations, and further establishes an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers.

UPMC offers a premier benefits package, designed to care for your total well-being - physically, emotionally, and financially - paired with endless opportunities for career advancement and growth. Discover the culture, the teams, and the passions that drive us to make Life Changing Medicine happen.


Responsibilities:

  • Provide leadership direction for provider credentialing processes.
  • Physicians must devote sufficient time to the CHC-MCO to provide timely medical decisions, including after-hours consultation, as needed
  • Provide leadership and direction in meeting Quality Improvement and Care Management goals directed at improvements in member health status outcomes and established business strategies.
  • Provide expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan.
  • Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and retrospective reviews, member grievances, provider appeals, and potential quality of care concerns.
  • Keep current with accepted standards and professional developments in the areas of quality improvement and utilization management.
  • Communicate and educate network providers regarding clinical guidelines, pathways, protocols, and standards related to quality and utilization processes.
  • Responsible for reporting the communication of reportable communicable diseases in accordance with statute.
  • Interacts with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and Quality Improvement policies and procedures.
  • Work with the DOH State and District Office Epidemiologists in partnership with the designated county/municipal health department staff to appropriately report reportable conditions in accordance with 28 Pa. Code 27.1 et seq.
  • Daily interventions support implementation of the Health Plan's Quality Improvement and Care Management Programs.
  • Represent the Health Plan in external accreditation and certification activities.
  • Act as first level physician reviewer for all cases referred by the Quality Improvement and Care Management Departments.
  • Daily activities support adherence to quality and utilization standards, and establish an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers.
  • Doctor of Medicine or Doctor of Osteopathy from an accredited school Required
  • The ideal candidates will have a minimum of 5-10 years of clinical experience
  • Managed Care experience preferred
  • Preference will be given to candidates with board certification in Internal Medicine, Family Medicine, Geriatric Medicine or Emergency Medicine
    Licensure, Certifications, and Clearances:
  • Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)

  • PA Medical License

UPMC is an Equal Opportunity Employer/Disability/Veteran

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