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Director Remote Utilization Review Jobs in Florida

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

ARC Group

Medical Director

Jacksonville, FL · Remote

MEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for a Medical Director! This ... Work experience in the health insurance industry, a utilization review firm, or another health care ...

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All JobsUtilization Review JobsDirector Remote Utilization Review JobsDirector Remote Utilization Review Jobs in Florida

Director Remote Utilization Review information

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

AspectDirector Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, advanced degree, and management experienceRegistered Nurse (RN) license, relevant clinical experience
Work EnvironmentOversees teams remotely, strategic planning, policy developmentConducts patient reviews, collaborates with healthcare providers, often remote or onsite
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare facilities

The main difference is that the Director Remote Utilization Review focuses on managing teams and policies remotely, while the Utilization Review Nurse performs clinical reviews directly related to patient care. The director has a broader strategic role, whereas the nurse role is more clinical and operational.

What is a Director of Remote Utilization Review?

A Director of Remote Utilization Review is a healthcare leader responsible for overseeing teams that assess the necessity, appropriateness, and efficiency of medical services, typically from a remote or virtual environment. This role ensures compliance with regulatory guidelines, optimizes resource use, and helps manage healthcare costs while maintaining quality patient care. Directors collaborate with physicians, nurses, and insurance providers to review clinical cases and develop utilization review strategies. They also monitor performance metrics and implement process improvements for remote teams.

How does a Director of Remote Utilization Review typically collaborate with clinical and administrative teams to ensure effective patient care management?

A Director of Remote Utilization Review plays a pivotal role in bridging clinical staff, case managers, and administrative teams to optimize patient care and resource utilization. This is often achieved through regular virtual meetings, data sharing, and cross-departmental strategy sessions to review utilization trends and address barriers to care. The director ensures that remote teams adhere to regulatory standards and organizational goals, fostering open communication to streamline workflows and resolve complex cases efficiently. Successful collaboration enhances patient outcomes, reduces unnecessary costs, and maintains compliance, all while supporting a positive remote team environment.

What are the key skills and qualifications needed to thrive as a Director of Remote Utilization Review, and why are they important?

To thrive as a Director of Remote Utilization Review, you need in-depth knowledge of healthcare regulations, utilization management processes, and a relevant clinical background, typically supported by an RN or other clinical licensure and experience in case management. Familiarity with utilization review software, electronic health records (EHR), and certifications such as CCM or UM are often required. Leadership, analytical thinking, and strong communication skills are vital for guiding teams and collaborating with stakeholders. These skills ensure effective oversight of remote teams, regulatory compliance, and optimal patient care outcomes.
What are the most commonly searched types of Remote Utilization Review jobs in Florida? The most popular types of Remote Utilization Review jobs in Florida are:
What cities in Florida are hiring for Director Remote Utilization Review jobs? Cities in Florida with the most Director Remote Utilization Review job openings:
Director Remote Utilization Review jobs near you
Infographic showing various Director Remote Utilization Review job openings in Florida as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, 1% Temporary, and 1% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Utilization Review RN (Remote)

HealthPlus Staffing

Fort Lauderdale, FL • Remote

$80K - $100K/yr

Full-time

Posted 18 days ago

Job description

Quick Job Details:

Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard business hours
Patient Volume: N/A
Job Requirements:

  • Active RN license with Multi-State/Compact license required
  • Minimum 2 years of Utilization Review experience
  • Minimum 3 years of clinical nursing experience (acute care/hospital preferred)
  • Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
  • Excellent communication, analytical, and critical thinking skills
  • Ability to work independently in a remote environment

Responsibilities:

  • Conduct admission, continued stay, and observation reviews
  • Apply medical necessity criteria to determine appropriate level of care
  • Review cases for Physician Advisor escalation when appropriate
  • Collaborate with physicians, case managers, and insurance payers
  • Support denial prevention, documentation improvement, and revenue cycle initiatives
  • Ensure compliance with payer guidelines and regulatory requirements
  • Analyze clinical and financial data to identify quality improvement opportunities

Compensation: Competitive; based on experience

Benefits: Comprehensive benefits package

About Us:

HealthPlus Staffing is a national leader in the healthcare staffing industry. We partner with top healthcare organizations nationwide to connect highly qualified professionals with outstanding career opportunities.

Our Promise:

  • We will put you in front of the decision makers.
  • We will provide feedback on your application.
  • We will work on your behalf to obtain as much information as possible to help you make a well-informed decision.

If you're interested in this opportunity, please submit an application or call 561-291-7787 to speak with one of our experienced consultants. We look forward to helping you find your next opportunity!

The HealthPlus Team