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Remote Insurance Utilization Review Jobs (NOW HIRING)

Dane Street, LLC

Utilization Review Physician

Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ... Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... insurance or managed care industry using medically accepted criteria to validate the medical ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing ... Comprehensive medical and supplemental health insurance, including vision, dental, life insurance ...

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

As of May 31, 2026, the average hourly pay for remote insurance utilization review 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 are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What are remote insurance utilization review jobs?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

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

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

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What job categories do people searching Remote Insurance Utilization Review jobs look for? The top searched job categories for Remote Insurance Utilization Review jobs are:
Remote Insurance Utilization Review jobs near you
Utilization Review Physician

Utilization Review Physician

Dane Street, LLC

Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days ago

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 requirements
  • Ability 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
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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