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Part Time Remote Utilization Review Jobs in Bethlehem, PA

All JobsUtilization Review JobsPart Time Remote Utilization Review JobsPart Time Remote Utilization Review Jobs in Bethlehem, PA

Part Time Remote Utilization Review information

See Bethlehem, PA salary details

$21

$41

$68

How much do part time remote utilization review jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for part time remote utilization review in Bethlehem, PA is $41.78, according to ZipRecruiter salary data. Most workers in this role earn between $33.03 and $47.98 per hour, depending on experience, location, and employer.

What is a part time remote utilization review?

A Part Time Remote Utilization Review position involves evaluating medical records and healthcare services to ensure they are necessary and appropriate, typically for insurance companies or healthcare providers. This job is performed remotely, allowing professionals to work from home or another location outside of a traditional office setting. Part-time roles generally require fewer hours than full-time positions, making them suitable for those seeking flexible schedules. Professionals in this role often have backgrounds in nursing or healthcare and use their expertise to review patient care for quality and cost-effectiveness.

What skills and qualifications are needed for a part time remote utilization review?

To thrive as a Part Time Remote Utilization Review Nurse, you need a current RN license, strong clinical judgment, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and systems such as InterQual or MCG is typically required. Excellent communication, critical thinking, and self-motivation are vital soft skills for coordinating care and making independent decisions remotely. These skills ensure accurate case evaluations, regulatory compliance, and effective collaboration with healthcare teams while working from a remote setting.

What challenges do part time remote utilization review professionals face, and how can they be managed?

Part-time remote utilization review professionals often face challenges such as balancing a variable workload, ensuring timely communication with healthcare providers, and staying current with changing insurance guidelines. Since much of the work is done independently, strong time management and self-motivation are essential to meet review deadlines. Regularly scheduled check-ins with the team and utilizing digital collaboration tools can help maintain connectivity and support. Staying organized and proactive in seeking clarification when needed can mitigate common challenges and lead to a successful experience in this role.

What is the difference between Part Time Remote Utilization Review vs Part Time Remote Claims Reviewer?

AspectPart Time Remote Utilization ReviewPart Time Remote Claims Reviewer
CredentialsTypically requires healthcare licenses (e.g., RN, MD) and utilization review certificationsUsually requires insurance or claims processing experience, with some industry-specific certifications
Work EnvironmentRemote, healthcare-focused, reviewing medical necessity and appropriateness of careRemote, insurance or healthcare claims processing, verifying coverage and claims accuracy
Employer & Industry UsageHospitals, insurance companies, healthcare organizationsInsurance companies, third-party administrators, healthcare payers

Part Time Remote Utilization Review and Part Time Remote Claims Reviewer both operate remotely but focus on different aspects of healthcare administration. Utilization reviewers assess medical necessity, while claims reviewers verify insurance claims. Understanding these differences helps job seekers find roles aligned with their skills and credentials.

What job categories do people searching Part Time Remote Utilization Review jobs in Bethlehem, PA look for?

The top searched job categories for Part Time Remote Utilization Review jobs in Bethlehem, PA are:

What cities near Bethlehem, PA are hiring for Part Time Remote Utilization Review jobs?

Cities near Bethlehem, PA with the most Part Time Remote Utilization Review job openings:

Part Time Remote Utilization Review jobs near you
Infographic showing various Part Time Remote Utilization Review job openings in Bethlehem, PA as of August 2026, with employment types broken down into 67% Part Time, and 33% Contract. Highlights an 100% Remote job distribution, with an average salary of $86,898 per year, or $41.8 per hour.

Nurse Reviewer - Allentown, PA

Healthcare Quality Strategies, Inc.

Allentown, PA • Remote

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Re-posted 8 days ago

Job description

Nurse Reviewer
PT (20-30 hours week) – Remote Work Environment
Non-Exempt: $40.00 hour
Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely.
Essential Duties and Responsibilities:
  • Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies
  • Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines
  • Document evidence-based criteria applicable to specific contract requirements
  • Record and report screening results, including relevant referral questions, into a centralized database
  • Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity
  • Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations
  • Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards
Knowledge, Experience, Skills and Education:
  • Medical terminology, ICD-10, CPT and HCPCS
  • Clinical criteria (InterQual and MCG)
  • Utilization/Medical record review and chart abstraction
  • Current standards of medical practice
  • Comply with HIPAA/HITECH laws and regulations
Experience in:
  • At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred)
  • Experience performing medical record review, audit for federal or state contracts
  • Knowledge and experience of Medicare and Medicaid policy
  • Proficiency with Microsoft Office (Word, Excel, and Outlook)
  • Proficiency with Adobe PDF files and features
  • Generating accurate, timely, and understandable correspondence
  • Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG)
Skills Requirements include:
  • Professional interpersonal skills; ability to interact with providers, physicians and peers
  • Solid analytical, assessment and documentation skills
  • Effective written and verbal communication, both internally and externally
  • Strong attention to detail
  • Strong attention to deadlines
  • Organizational skills including effective time management, priority setting and process improvement
  • Ability to work independently and as a member of a team
  • Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations
Educational Background:
  • BSN with active RN licensure in good standing
Physical Demands:
Remote Work, Prolonged Sitting, Screen Exposure
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD amp;D, voluntary life/AD amp;D, 401k
For immediate consideration, please apply via the HQSI Careers Page at: www.hqsi.org gt; Careers gt; Current Employment Opportunities
EOE: Minorities/Females/Disabled/Veterans
Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace
Healthcare Quality Strategies, Inc. is an E-Verify Employer

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