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Remote Dental Utilization Management Jobs (NOW HIRING)

Intus, Inc

Utilization Management Nurse

$80K - $95K/yr

Comprehensive benefits including health, dental, and vision insurance. * A collaborative, inclusive ... This is a fully remote role based in the United States. Sponsorship: This position is not eligible ...

Dignity Health Management Services

$57.37 - $85.33/hr

As a remote employee, we will provide you with the equipment needed to work from home, including a ... Previous inpatient Utilization Management (UM) experience strongly preferred * Experience with MCG ...

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Remote Dental Utilization Management information

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How much do remote dental utilization management jobs pay per hour?

As of Jul 28, 2026, the average hourly pay for remote dental utilization management in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What is the difference between Remote Dental Utilization Management vs Remote Dental Claims Processing?

AspectRemote Dental Utilization ManagementRemote Dental Claims Processing
Primary RoleReviewing and authorizing dental treatments based on medical necessityProcessing and adjudicating dental insurance claims for reimbursement
Required SkillsDental knowledge, review protocols, insurance policiesClaims coding, data entry, insurance guidelines
Work EnvironmentRemote, healthcare/insurance industryRemote, insurance/healthcare industry
CertificationsDental credentials often preferred; insurance knowledgeClaims processing certifications, insurance knowledge

Remote Dental Utilization Management focuses on evaluating dental treatments for necessity, while Remote Dental Claims Processing handles the financial reimbursement process. Both roles are essential in dental insurance workflows but differ in responsibilities and skill sets.

What are some common challenges faced by professionals in Remote Dental Utilization Management roles?

Professionals in Remote Dental Utilization Management often encounter challenges such as staying updated on evolving dental policies and coverage criteria, as well as interpreting complex clinical documentation without direct patient interaction. Communicating effectively with providers and patients via phone or email, rather than in-person, can also be demanding. Additionally, balancing productivity expectations with the need for careful, accurate reviews requires strong time management and attention to detail. Collaborating virtually with team members and adapting to new technologies are also important aspects of the role.

What are the key skills and qualifications needed to thrive as a Remote Dental Utilization Management professional, and why are they important?

To thrive as a Remote Dental Utilization Management professional, you need a background in dental hygiene or dentistry, strong analytical abilities, and knowledge of insurance guidelines, usually supported by credentials such as RDH, DDS, or DMD. Familiarity with dental claims processing software, electronic health record (EHR) systems, and utilization review platforms is typically required. Exceptional communication, attention to detail, and critical thinking skills help professionals effectively assess claims and collaborate with providers. These competencies are essential to ensure accurate adjudication, cost control, and high levels of service in remote dental benefits management.

What is a Remote Dental Utilization Management job?

A Remote Dental Utilization Management job involves reviewing dental treatment plans and claims to ensure they meet established clinical guidelines and policies, all while working from a remote location. Professionals in this role assess the necessity and appropriateness of dental services, help control costs, and may interact with dentists, patients, and insurance companies. They often use their dental expertise to make recommendations or decisions about coverage and authorizations. This position typically requires a background in dentistry or dental hygiene, strong analytical skills, and familiarity with insurance processes.
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What cities are hiring for Remote Dental Utilization Management jobs? Cities with the most Remote Dental Utilization Management job openings:
What are the most commonly searched types of Dental Utilization Management jobs? The most popular types of Dental Utilization Management jobs are:
What states have the most Remote Dental Utilization Management jobs? States with the most job openings for Remote Dental Utilization Management jobs include:
What job categories do people searching Remote Dental Utilization Management jobs look for? The top searched job categories for Remote Dental Utilization Management jobs are:
Remote Dental Utilization Management jobs near you
Utilization Management Specialist

Utilization Management Specialist

System One

Baltimore, MD • Remote

Contractor

Medical, Dental, Vision, Life, Retirement

Posted 5 days ago

Job description

Utilization Management Specialist (UM / Utilization Review Nurse) — Remote

Location: 100% Remote (U.S.) — Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension) Schedule: Mon–Fri, 8:00am–5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am–9:00am ET Pay (W2): USD 51.00/H

Job overview

In this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You’ll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.

What you’ll do

  • Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).
  • Make medical necessity / appropriateness determinations and support prior authorizations.
  • Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines).
  • Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines.
  • Research diagnoses/treatments and high-cost services; summarize findings and escalate complex cases to Medical Directors as needed.
  • Collaborate with internal partners and providers to support benefit application and appropriate levels/settings of care.
  • Maintain accurate documentation and protect PHI while managing a busy caseload.

Required qualifications

  • Active RN or LPN license (RN preferred) — Maryland compact/eligibility required
  • 5+ years clinical nursing experience
  • 2+ years care management / utilization management experience
  • MCG experience (required)
  • Experience supporting Commercial/FEP/Medicare lines of business and applying medical policy/regulatory standards
  • Strong critical thinking, written communication, and ability to work independently in a remote setting
  • Comfortable with web-based tools + Microsoft Office (Word/Excel/PowerPoint)
  • Guiding Care and FACETS (required)

Nice to have

  • Critical Care or ER clinical background
  • Experience with LCD/NCD, Medicare guidelines, ASAM, or other authorization criteria sets

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1