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Remote Chiropractic Utilization Review 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;

YO AI Labs

Hospitalist Physician - Remote

Atlanta, GA · Remote

$70 - $100/hr

Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...

HCRC Staffing

Neurologist Atlanta GA

Atlanta, GA · Remote

$300K - $550K/yr

Neurologist Atlanta GA Remote/Telehealth only We are looking for a Neurologist to join our growing ... Diagnostic testing/imaging review as needed * Provide patient education on condition, therapy ...

Integrated Resources INC

Case Manager

Alpharetta, GA · Remote

$19.50 - $25.25/hr

... reviews utilization of mental health and substance abuse services provided in inpatient and ... The Alpharetta, GA candidate will also have the ability to work remote. This is an inbound ...

Harris

Build and present performance reviews and executive-ready reporting; drive corrective action plans ... Recommend technology improvements (automation, templates, dashboards, portal utilization) to ...

Harris

Build and present performance reviews and executive-ready reporting; drive corrective action plans ... Recommend technology improvements (automation, templates, dashboards, portal utilization) to ...

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Remote Chiropractic Utilization Review information

What is a remote chiropractic utilization review?

A Remote Chiropractic Utilization Review is a process where licensed chiropractors or healthcare professionals assess the necessity, efficiency, and appropriateness of chiropractic care provided to patients, but do so remotely—often from home or a centralized office. This review typically involves examining patient records, treatment plans, and billing information to ensure that care meets established clinical guidelines and insurance requirements. The goal is to improve patient outcomes, prevent unnecessary treatments, and ensure that services billed to insurance are medically necessary. Remote reviews use secure online systems and may require coordination with treating chiropractors, insurance companies, and other healthcare providers.

What are the key skills and qualifications needed to thrive as a remote chiropractic utilization review specialist?

To thrive as a Remote Chiropractic Utilization Review specialist, you need a Doctor of Chiropractic degree, a valid state license, and comprehensive knowledge of chiropractic procedures and medical necessity guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certification such as Certified Professional Utilization Review (CPUR) is often required. Strong analytical skills, attention to detail, and effective communication are crucial for evaluating clinical documentation and collaborating with providers. These skills ensure accurate, evidence-based reviews that support appropriate patient care and compliance with insurance standards.

What are some common challenges faced in a remote chiropractic utilization review role, and how can they be managed?

One of the main challenges in a remote Chiropractic Utilization Review role is effectively evaluating clinical documentation to ensure treatment appropriateness without direct patient interaction. Communication with providers can sometimes be limited or delayed, requiring strong written and verbal skills to clarify cases efficiently. Managing time and workflow independently is crucial, as the workload may fluctuate throughout the week. Staying updated with payer guidelines and evidence-based practices is also essential for accurate reviews. Building strong virtual collaboration with team members and providers can help overcome these challenges and maintain high-quality standards.

What is the difference between Remote Chiropractic Utilization Review vs Remote Chiropractic Billing Specialist?

AspectRemote Chiropractic Utilization ReviewRemote Chiropractic Billing Specialist
Primary RoleAssessing medical necessity and appropriateness of chiropractic treatmentsManaging billing, coding, and insurance claims for chiropractic services
Required CredentialsChiropractic license, possibly certifications in utilization reviewMedical billing certifications, knowledge of coding and insurance policies
Work EnvironmentRemote, healthcare or insurance companiesRemote, healthcare providers or billing companies
Industry UsageUsed by insurance companies and healthcare organizations to approve treatmentsUsed by billing companies and healthcare providers for claims processing

Remote Chiropractic Utilization Review focuses on evaluating the medical necessity of chiropractic treatments, while Remote Chiropractic Billing Specialist handles billing, coding, and insurance claims. Both roles are remote and require healthcare knowledge, but they serve different functions within the chiropractic industry.

What are the most commonly searched types of Chiropractic Utilization Review jobs in Georgia?

The most popular types of Chiropractic Utilization Review jobs in Georgia are:

What are popular job titles related to Remote Chiropractic Utilization Review jobs in Georgia?

For Remote Chiropractic Utilization Review jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Remote Chiropractic Utilization Review jobs in Georgia look for?

The top searched job categories for Remote Chiropractic Utilization Review jobs in Georgia are:

What cities in Georgia are hiring for Remote Chiropractic Utilization Review jobs?

Cities in Georgia with the most Remote Chiropractic Utilization Review job openings:

Remote Chiropractic Utilization Review jobs near you
Infographic showing various Remote Chiropractic Utilization Review job openings in Georgia as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 13% Part Time, 7% Contract, and 3% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Review Nurse

Atlanta, GA • Remote

Oscar Health
Insurance Services • 1 - 5K employees

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

262nd of 315 rated insurance

Respectful managers

Uninterrupted breaks

Learn more about Oscar Healthexternal

$35 - $45.94/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 7 days ago

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; 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) or InterQual
  • 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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