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Remote Insurance Utilization Review Jobs (NOW HIRING)

Gateway Rehab

Utilization Review Liaison - REMOTE

Comprehensive benefits package, including contribution toward the medical insurance plan of your ... Why This Role is Important to SUD Treatment GRC's Utilization Review team is changing lives, and as ...

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

... Insurance • 401k/403B with Employer Match • Tuition Assistance - 5,250/year and discounted ... For positions that are available as remote work, Sentara Health employs associates in the following ...

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 ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ... Medical, Dental and Vision plans Life Insurance Flexible Spending Account Other voluntary benefit ...

Cobalt Benefits Group

Utilization Review Nurse

As a Utilization Review Nurse, you'll play an important role in helping us offer customized, self-funded insurance options to our clients and members. The UR Nurse is responsible for reviewing ...

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

As of Sep 10, 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 is a remote insurance utilization review?

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 skills and qualifications are needed for a remote insurance utilization review specialist?

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 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.

More about Remote Insurance Utilization Review jobs

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Cities with the most Remote Insurance Utilization Review job openings:

What are the most commonly searched types of Insurance Utilization Review jobs?

The most popular types of Insurance Utilization Review jobs are:

What states have the most Remote Insurance Utilization Review jobs?

States with the most job openings for Remote Insurance Utilization Review jobs include:

What are popular job titles related to Remote Insurance Utilization Review jobs?

For Remote Insurance Utilization Review jobs, the most frequently searched job titles are:

Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in the United States as of September 2026, with employment types broken down into 82% Full Time, and 18% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Liaison - REMOTE

Remote

Gateway Rehab
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about Gateway Rehabexternal

Full-time

Medical

Posted 7 days ago

Job description

Job Type
Full-time
Description
Gateway Rehab Center (GRC) is hiring a full-time Utilization Review Liaison! In this important administrative and clinical support role, you will help ensure patients receive the appropriate level of care by coordinating authorizations, conducting utilization reviews, and collaborating with clinical teams and insurance providers to support treatment coverage and reimbursement. This position is fully remote and offers the opportunity to make a meaningful impact on patient access to care from your home office. To be considered for the position, you must live within the Pittsburgh, PA area or surrounding counties.
If you're detail-oriented, organized, and enjoy working at the intersection of patient care, insurance, and healthcare operations, keep reading!
Why You'll Love Working at GRC
  • Mission-driven work supporting individuals and families impacted by addiction.
  • Opportunity to play a vital role in ensuring access to treatment services.
  • Collaborative environment working alongside clinical, admissions, and billing teams.
  • Meaningful work that helps patients receive the care they need throughout their recovery journey.
  • Comprehensive benefits package, including contribution toward the medical insurance plan of your choice: Highmark or UPMC, plus access to employee discount programs and additional supportive benefits!

Why This Role is Important to SUD Treatment
GRC's Utilization Review team is changing lives, and as a Utilization Review Liaison, you'll be at the forefront of this effort. By securing and maintaining treatment authorizations, monitoring coverage, and advocating for continued care when needed, you help remove barriers to treatment and ensure patients have access to critical recovery services. Your work directly supports quality patient care, treatment continuity, and organizational success. This is more than an administrative role. It's an opportunity to make a lasting impact on recovery every day.
Responsibilities:
  • Gather clinical information needed for concurrent and retrospective reviews.
  • Complete concurrent and retrospective review processes with payors for treatment authorization.
  • Collaborate with utilization review team members and clinical staff to prepare for reviews and maintain daily workflow.
  • Enter authorization information into the patient database.
  • Communicate authorization status updates to clinical staff.
  • Monitor patients' last covered day of treatment and notify appropriate staff of upcoming coverage expirations.
  • Investigate and resolve issues involving incomplete or missing authorizations.
  • Identify errors that could negatively impact reimbursement for patient treatment.
  • Collaborate with multiple departments to ensure continuity of treatment coverage.
  • Educate clinical and support staff regarding county-funded, managed care, and commercial insurance procedures.
  • Complete peer-to-peer reviews as needed.
  • Communicate discharge information to funding sources when required.
  • Coordinate with clinical teams to ensure funding sources are notified of patient status changes.
  • Investigate denied claims and assist in efforts to recover payment for services rendered.
  • Attend managed care provider meetings as needed.
  • Participate in required GRC trainings and in-service programs.

What You Bring
  • Strong understanding of utilization review, insurance authorization processes, and managed care practices.
  • Excellent verbal and written communication skills.
  • Strong organizational skills and attention to detail.
  • Ability to manage multiple priorities in a fast-paced environment.
  • General understanding of ASAM Criteria.
  • Familiarity with substance use disorder, mental health, and behavioral healthcare treatment services.
  • Strong problem-solving and critical-thinking abilities.
  • Proficiency in Microsoft Office applications, including Word, Excel, and email systems

Requirements
What Do We Require?
  • Bachelor's degree.
  • Familiarity with drug and alcohol treatment, mental health treatment, and/or managed care processes.
  • Proficiency with computer systems and Microsoft Office applications.

Preferred Qualifications
  • Master's degree.
  • Registered Nurse (RN) with current Pennsylvania licensure.
  • Previous experience with utilization review, managed care, insurance authorizations, or healthcare reimbursement processes.

Additional Requirements
  • Pass a PA Criminal Background Check.
  • Obtain PA Child Abuse and FBI Fingerprinting Clearances.
  • Pass a Drug Screen.
  • Complete a 2-Step TB Test.

What Are the Work Conditions?
  • Remote.
  • Prolonged periods of sitting and working on a computer.
  • Minimal physical demands.
  • Significant attention to detail required.
  • Mental demands include problem-solving complex coverage issues, analyzing authorization requirements, and coordinating information across multiple departments.

GRC is an Equal Opportunity Employer committed to diversity, equity, inclusion, and belonging. We value diverse voices and lived experiences that strengthen our mission and impact.

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