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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 ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

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

As of Jul 11, 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 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.

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 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.
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Remote Insurance Utilization Review jobs near you

Utilization Review Coordinator | Remote

Atlantic Health Strategies

Boca Raton, FL • On-site, Remote

$50K - $80K/yr

Full-time

Posted 11 days ago

Job description


About the Organization
Lotus Healthcare Billing is a behavioral health billing operation based in Boca Raton, Florida, supporting treatment programs through insurance authorization, utilization review, and payer communication. The team works closely with clinical staff to ensure that patients can access the levels of care they need, from detox through outpatient services.
The Opportunity
We are seeking a detail-oriented Utilization Review Coordinator to join the Lotus Healthcare Billing team. This full-time, remote role is well suited to someone who is organized, communicates clearly, and is comfortable managing a caseload where timelines directly affect patient care. A hybrid schedule with time in the Boca Raton office may be available for the right candidate. No prior utilization review experience is required. Training will be provided for the right candidate.
What You'll Do
  • Conduct daily phone contact with insurance companies to secure authorizations for behavioral health and substance use disorder treatment.
  • Manage a caseload of active authorizations, tracking timelines closely since they directly affect patient care.
  • Apply knowledge of SUD and behavioral health levels of care, including detox, residential, PHP, IOP, and outpatient, when communicating with payers.
  • Reference ASAM criteria and medical necessity standards to support authorization requests.
  • Use systems such as KIPU, Availity, or other payer portals to document and track review activity.
  • Communicate professionally and consistently with insurance representatives and internal clinical teams.
  • Work independently while staying aligned with program and compliance expectations.

Requirements
Requirements
  • High school diploma or equivalent required; associate's or bachelor's degree a plus.
  • Less than one year of relevant experience required; training provided for the right candidate.
  • Experience in utilization review, insurance authorization, or behavioral health billing preferred.
  • Familiarity with SUD/behavioral health levels of care (detox, residential, PHP, IOP, OP) is a strong plus.
  • Knowledge of ASAM criteria and medical necessity standards a plus.
  • Experience with KIPU, Availity, or payer portals preferred.
  • Strong organizational skills and attention to detail.
  • Clear, professional communication skills.
  • Comfortable working independently and managing a caseload.
  • Reliable home internet and a private, HIPAA-compliant workspace for remote work.

Benefits
Compensation and Schedule
  • Salary: $50,000 to $80,000 annually, commensurate with experience.
  • Schedule: Days, full-time, remote (hybrid option available for the right candidate).

This opportunity is posted by Atlantic Health Strategies on behalf of Lotus Healthcare Billing in Boca Raton, Florida.

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