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Entry Level Utilization Review Remote Jobs in Georgia

Oscar Health

Utilization Review Nurse

Atlanta, GA · 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;

Oscar Health

Sr. Quality of Care Review Nurse

Atlanta, GA · Remote

$83K - $109K/yr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas ... Health plan utilization management experience or case management experience. * Experience in health ...

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All JobsUtilization Review JobsEntry Level Utilization Review Remote JobsEntry Level Utilization Review Remote Jobs in Georgia

Entry Level Utilization Review Remote information

What is the difference between Entry Level Utilization Review Remote vs Entry Level Medical Coder Remote?

AspectEntry Level Utilization Review RemoteEntry Level Medical Coder Remote
Required CertificationsUtilization Review Certification, possibly a healthcare or insurance-related licenseCertified Coding Associate (CCA) or Certified Professional Coder (CPC)
Work EnvironmentRemote, healthcare or insurance companiesRemote, healthcare facilities, or coding companies
Industry UsageHealthcare insurance, utilization managementMedical billing, coding, healthcare documentation
Common Search/ComparisonYesYes

Entry Level Utilization Review Remote and Entry Level Medical Coder Remote both operate in healthcare but focus on different tasks. Utilization reviewers assess medical necessity for services, requiring certifications in utilization review. Medical coders translate medical records into codes, requiring coding certifications. Both roles are remote and essential in healthcare administration, but they serve distinct functions within the industry.

How to start as an entry level utilization review remote?

To start as an entry-level utilization review remote, candidates typically need a high school diploma or equivalent, with some roles preferring a healthcare-related certification such as a Certified Medical Reimbursement Specialist (CMRS). Relevant skills include attention to detail, knowledge of medical terminology, and proficiency with electronic health records (EHR) systems; some employers may also require prior healthcare or insurance experience. Applying through online job boards and demonstrating strong communication and organizational skills can help secure an entry-level position in this field.
What are popular job titles related to Entry Level Utilization Review Remote jobs in Georgia? For Entry Level Utilization Review Remote jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Entry Level Utilization Review Remote jobs in Georgia look for? The top searched job categories for Entry Level Utilization Review Remote jobs in Georgia are:
Entry Level Utilization Review Remote jobs near you
Infographic showing various Entry Level Utilization Review Remote job openings in Georgia as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Review Nurse

Oscar Health

Atlanta, GA • Remote

$35 - $45.94/hr

Full-time

Posted 15 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

251st of 303 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

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; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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