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Humana Utilization Review Remote Jobs (NOW HIRING)

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

Remote : Mondays and Fridays * On-site in our Denver Office: Tuesdays, Wednesdays, and Thursdays The compensation range for this position is based upon candidate experience and market expectations.

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

... all Utilization Management activities to include review of inpatient and outpatient medical ... Remote Contract to Hire VIVA is an equal opportunity employer. All qualified applicants have an ...

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How much do humana utilization review remote jobs pay per hour?

As of Jun 6, 2026, the average hourly pay for humana utilization review remote in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

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

AspectHumana Utilization Review RemoteHumana Utilization Review Nurse
CredentialsTypically requires a nursing license (RN) and relevant certificationsRequires an RN license and clinical experience
Work EnvironmentRemote, home-based settingRemote, home-based setting
Employer & IndustryHumana, health insurance industryHumana, health insurance industry
Job FocusReviewing medical necessity and coverage for insurance claimsAssessing patient care plans and medical necessity

Both roles involve remote work within the health insurance industry and require nursing credentials. The main difference is that the Humana Utilization Review Nurse typically involves direct clinical assessment and patient care review, whereas the Humana Utilization Review Remote may focus more on administrative review of claims and coverage decisions.

Infographic showing various Humana Utilization Review Remote job openings in the United States as of May 2026, with employment types broken down into 3% As Needed, 71% Full Time, 13% Part Time, and 13% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Physician

Utilization Review Physician

Dane Street

Manhattan, NY • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Overview We are seeking a high-performing Physician Reviewer to join our Group Health division. The role is responsible for delivering timely, defensible utilization review determinations across a high-volume, fast-paced environment. Reviews span multiple case types, including preauthorization, appeals, DRG clinical validation, benefit review, and experimental/investigational determinations.

Key Responsibilities Perform utilization review for: Preauthorization requests Appeals (first and second level) Independent external reviews DRG validation and clinical review Benefit and coverage determinations Experimental/Investigational (E/I) review Apply evidence-based criteria and guidelines, including: InterQual MCG CMS guidelines (including 2-Midnight Rule) LCD/NCD Client-specific policies Produce clear, concise, and defensible clinical rationales Maintain high accuracy and consistency across determinations Meet or exceed turnaround time (TAT) expectations, including urgent cases Participate in peer-to-peer discussions as needed Collaborate with QA and operational teams to ensure quality and compliance Reviews may be conducted within internal systems or client-specific platforms, depending on assignment and client requirements Performance Metrics High daily review volume with strong accuracy Consistent adherence to client-specific requirementsAbility to manage short-TAT and urgent cases efficiently Clear, audit-ready documentation Required Qualifications MD or DO, board-certified in Internal Medicine, Family Medicine, or similar Active, unrestricted medical license Prior utilization review experience, preferably in a health plan or IRO environment Familiarity with InterQual, MCG, and CMS guidelines Strong clinical judgment and documentation skills Ability to work independently in a high-throughput environment Technical Skills Proficiency with standard business tools (e.g., Google Workspace, Microsoft Office) Comfortable working across multiple systems, including internal platforms and client-specific portals Strong navigation and documentation skills within web-based applications Ability to manage multiple systems/screens simultaneously in a high-throughput environment Familiarity with Mac operating systems Work Environment Remote work from home Full-time, Monday–Friday Availability for occasional weekends and holiday coverage for urgent reviews Benefits Medical, dental, and vision coverage for you and your family Voluntary life insurance options for you, your spouse, and your children Other voluntary benefits: hospital indemnity, critical illness, accident indemnity, pet insurance plans Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost Generous paid time off policy 401(k) plan with company match Apple equipment and media stipend for remote workspace #J-18808-Ljbffr

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