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Director Remote Utilization Review Jobs in Florida

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Director Remote Utilization Review information

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 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 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.

Medical Director Utilization Management Oncology

Starling Oncology

Miami, FL • Remote

$275K - $325K/yr

Full-time

Posted 29 days ago

Job description

Starling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With more than 400 employed and network clinicians and over 100 clinics and network locations of care across five states and growing, Starling Oncology is changing oncology for the better. For more information, visit www.starlingoncology.com.

Utilization Management Medical Director Oncology

Work Location: REMOTE (work from home)

California Nevada Arizona Oregon Florida

The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with a focus on direct utilization management for case review and clinical decision making.

In this collaborative role, you will work with physicians, clinical teams and operational leaders to support evidence-based high quality and cost-effective care delivery across the network. You will also contribute to cross-functional initiatives, data-driven insights, and oversight of utilization management policies to optimize patient outcomes.

 Key Responsibilities:

  • Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices.
  • Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.
  • Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness.
  • Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage.
  • Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement
  • Partner with clinical and operational teams to support value-based care.
  • Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions.
  • Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology.

Qualifications:

  • Medical degree (MD or DO)
  • Board Certification in Oncology.
  • Minimum of 5 years of clinical experience in oncology.
  • 2+ years of Utilization Management experience
  • Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans.
  • Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies.
  • Excellent analytical skills and the ability to evaluate complex clinical data.
  • Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting.
  • Excellent communication skills to engage effectively with healthcare providers, payers, and patients.

If you're interested in learning more, but not ready to apply, please reach out to our team to set-up a call at your convenience. Physiciancareers@theoncologyinstitute.com

Ready to apply? Please complete the simple application and our team will reach out to you quickly.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role.

Pay Transparency for salaried teammates
$275,000—$325,000 USD