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Remote Case Reviewer Jobs (NOW HIRING)

State of Colorado

Administrative Reviewer

Denver, CO · On-site +1

$6.0K - $9.6K/mo

The federally required child welfare Case Review and Qualitative Case Review systems ... This position follows a hybrid work arrangement, combining remote work with regular travel. The ...

State of Colorado

Administrative Reviewer

Denver, CO · On-site +1

$6.0K - $9.6K/mo

The federally required child welfare Case Review and Qualitative Case Review systems ... This position follows a hybrid work arrangement, combining remote work with regular travel. The ...

OncoHealth

Case Review Specialist - Atlanta

Atlanta, GA · On-site +1

About the Role The Case Review Specialist ensures that case documentation is provided by the ... Experience working remote independently * A minimum of 2-4 years' administrative experience and/or ...

OncoHealth

Case Review Specialist - Atlanta

Atlanta, GA · On-site +1

About the Role The Case Review Specialist ensures that case documentation is provided by the ... Experience working remote independently * A minimum of 2-4 years' administrative experience and/or ...

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Case Manager - Remote

Dallas, TX · Remote

$20/hr

(Case Manager) - Remote Location: Fully Remote (U.S.) Job Type: Full-Time Pay Rate: $20.00 per hour ... Review documentation for accuracy, completeness, and compliance requirements * Maintain detailed ...

OncoHealth

Case Review Specialist - PR

Guaynabo, PR · On-site +1

About the Role The Case Review Specialist ensures that case documentation is provided by the ... Remote/hybrid experience preferred * A minimum of 2-4 years' administrative experience and/or ...

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All JobsRemote Case Reviewer Jobs

Remote Case Reviewer information

See salary details

$19

$47

$80

How much do remote case reviewer jobs pay per hour?

As of Jun 29, 2026, the average hourly pay for remote case reviewer in the United States is $47.53, according to ZipRecruiter salary data. Most workers in this role earn between $35.34 and $57.45 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote Case Reviewer, and why are they important?

To thrive as a Remote Case Reviewer, you need strong analytical skills, attention to detail, and relevant professional credentials, often in fields like healthcare, insurance, or law. Familiarity with case management software, electronic documentation systems, and industry regulations (such as HIPAA for healthcare) is typically required. Excellent written communication, time management, and independent decision-making are standout soft skills for this role. These abilities ensure accurate, compliant, and efficient case evaluations while maintaining high-quality standards in a remote work environment.

What is the difference between Remote Case Reviewer vs Remote Claims Processor?

AspectRemote Case ReviewerRemote Claims Processor
Required CredentialsHigh school diploma or equivalent; healthcare or legal background often preferredHigh school diploma or equivalent; experience in insurance or claims processing beneficial
Work EnvironmentHome-based, independent review settingHome-based, processing insurance claims
Industry UsageHealthcare, legal, insurance sectorsInsurance companies, third-party administrators
Common Search/ComparisonRemote Case Reviewer vs Remote Claims Processor

While both roles are remote and involve handling cases or claims, Remote Case Reviewers primarily evaluate and assess cases, often requiring specialized knowledge in healthcare or legal fields. Remote Claims Processors focus on processing insurance claims, verifying information, and ensuring accurate payment. Understanding these differences helps job seekers identify the role that best matches their skills and career goals.

What are some common challenges Remote Case Reviewers face, and how can they effectively manage them?

Remote Case Reviewers often encounter challenges such as managing a high volume of cases, staying organized with digital documentation, and maintaining clear communication with team members across different locations. To address these, it's important to develop strong time management skills, utilize standardized review checklists, and take advantage of collaboration tools like secure messaging platforms. Regular virtual meetings and clear protocols help ensure consistency and quality, while ongoing training can keep reviewers up to date on best practices.

What are remote case reviewers?

Remote case reviewers are professionals who assess and evaluate cases, such as medical, legal, or insurance files, from a remote location rather than working on-site. Their responsibilities typically include reviewing documentation, ensuring compliance with policies and regulations, and providing recommendations or decisions based on their findings. Remote case reviewers use secure digital platforms to access and analyze case materials, enabling flexibility and efficiency in their work. This role can be found in industries like healthcare, law, insurance, and finance. Strong attention to detail and analytical skills are essential for success in this position.
More about Remote Case Reviewer jobs
What cities are hiring for Remote Case Reviewer jobs? Cities with the most Remote Case Reviewer job openings:
What are the most commonly searched types of Case Reviewer jobs? The most popular types of Case Reviewer jobs are:
What states have the most Remote Case Reviewer jobs? States with the most job openings for Remote Case Reviewer jobs include:
What job categories do people searching Remote Case Reviewer jobs look for? The top searched job categories for Remote Case Reviewer jobs are:
Remote Case Reviewer jobs near you
Infographic showing various Remote Case Reviewer job openings in the United States as of June 2026, with employment types broken down into 79% Full Time, 7% Part Time, and 14% Temporary. Highlights an 100% Remote job distribution, with an average salary of $98,869 per year, or $47.5 per hour.
Case Manager - Utilization Review Specialist - Remote

Case Manager - Utilization Review Specialist - Remote

Quorum Health

Brentwood, TN • On-site, Remote

Full-time

Posted 19 days ago

Key responsibilities

  • Analyzes patient records and insurance standards to determine legitimacy of admission, treatment, and length of stay.

  • Reviews and manages appeals of denied claims and ensures timely submission and documentation of appeals.

  • Coordinates with medical staff and other departments to resolve denial and appeal questions and monitors compliance with appeal decision time frames.

Quorum Health rating

6.5

Company rating: 6.5 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

Job description

Case Manager - Utilization Review Specialist - Remote
The Utilization Review Specialist assumes responsibility and accountability for admission and concurrent reviews assuring the prevention of denials from all payers, as well as appeals of all accounts reviewed and deemed appropriate for appeal. The Specialist will create a structure for resolution of root cause denial trends by continuously working to identify opportunities for workflow improvements.
KEY JOB RESPONSIBILITIES:
  • Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility to comply with government and insurance company reimbursement policies: Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
  • Reviews application for patient admission and approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards.
  • Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay.
  • Abstracts data from records and maintains statistics.
  • Determines patient review dates according to established diagnostic criteria.
  • May assist the review committee in planning and holding federally mandated quality assurance reviews.
  • May supervise and coordinate activities of utilization review staff.
  • Research clinical records, appropriate insurance regulations and history of claim to determine next step
  • Monitor day to day compliance of appeal decision time frames and collaborate with other departments to ensure timely resolution of issues or appeals.
  • Review clinical and medical records for completeness and determine administrative or clinical appeal. Assign reviews to physician advisors and medical directors for those requiring medical necessity reviews.
  • Coordinate first, second and third level appeals.
  • Consults with managers on problem cases and interfaces with case managers, clinical supervisors, account managers and other personnel in resolving denial and appeal questions.
  • Ensure proper documentation of all denials into billing systems to include tracking outcome for reporting to appropriate parties
  • Manage appeals to ensure timely submissions
  • Monitor volume of appeals in order to engage additional resources when needed.
  • Form professional relationships with payer appeals and utilization departments
  • Enter all data related to appeals and case reviews into a database.
  • Prepare and present information on appeals to applicable committees and personnel as requested.
  • Prepare for and complete appeals audits.
  • Monitor and report QI (Quality Improvement) activities of appeals department.
  • Demonstrate ability to draft professional appeal letter by incorporating supporting documents, policies and statutes.
  • Other duties as assigned.

EDUCATION/TRAINING & EXPERIENCE:
Current state-issued RN license. Knowledge in areas such as InterQual Level of Care Criteria and Milliman & Robertson Criteria as well as knowledge of third party payer regulations related to utilization and quality review is also preferred.
EXPERIENCE / SKILLS:
  • Significant experience in the healthcare field is required including a minimum of five years as a clinical nurse in an acute care setting. In addition, having at least five to seven years of experience in case management, discharge planning, and/or utilization review is preferred.
  • Knowledge of regulatory and payer requirements for Case Management Activities..
  • Ability to critically evaluate and make decisions about whether discharge planning for highly difficult cases
  • Ability to use pre-existing criteria sets and/or clinical evidence from an existing library of clinical references and/or regulatory arguments to support one's own clinical appeals arguments
  • Maintains confidentiality of patient data and medical records in compliance with HIPAA regulations.
  • Ability to read, evaluate, and abstract important information from handwritten patient medical records.
  • Excellent oral and technical writing and typing skills.
  • Demonstrates flexibility with a willingness to learn and adapt to changes in regulations and task-related priorities.
  • Ability to successfully work independently and to adapt quickly to changing priorities and regulations. Excellent oral and technical writing skills and the Ability to maintain confidentiality according to HIPAA regulations is required.
  • Other duties as assigned.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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