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Remote Insurance Utilization Review Jobs in Connecticut

Amgen

Field Reimbursement Manager - Hartford, CT

Hartford, CT · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Review patient insurance benefit options and alternate funding/financial assistance programs ... General office demands - Remote, Work from Home. * One to two home office days per week. * Must be ...

Valeris

Remote Registered Nurse (RN) Case Manager

Hartford, CT · Remote

$50K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus. * Case ...

Valeris

Remote Registered Nurse (RN) Case Manager

Danbury, CT · Remote

$50K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus. * Case ...

Worldwide Clinical Trials

$223K/yr

Review and assess ongoing budget utilization and revenue recognition with Operations Managers to ensure projects are meeting financial targets * Manage internal CAT operations meetings and other ...

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All JobsInsurance Utilization Review JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Connecticut

Remote Insurance Utilization Review information

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.

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

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

What job categories do people searching Remote Insurance Utilization Review jobs in Connecticut look for?

The top searched job categories for Remote Insurance Utilization Review jobs in Connecticut are:

What cities in Connecticut are hiring for Remote Insurance Utilization Review jobs?

Cities in Connecticut with the most Remote Insurance Utilization Review job openings:

Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Connecticut as of August 2026, with employment types broken down into 94% Full Time, and 6% Contract. Highlights an 100% Remote job distribution.

Remote Registered Nurse (RN) Case Manager

PharmaCord LLC

Danbury, CT • On-site, Remote

$50K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 5 days ago

PharmaCord rating

7.0

Company rating: 7.0 out of 10

Based on 12 frontline employees who took The Breakroom Quiz

265th of 492 rated business services

Job description

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.
As a Nurse Advocate you are responsible for contact with program patients and assessing any barriers that may be present for successful initiation and completion of therapy. The Nurse Advocate will play an active role with each patient from the first point of patient program enrollment and throughout treatment to facilitate a timely and successful patient experience.
Key Responsibilities:
  • Serve as a consistent resource throughout the continuum of program services, which includes identifying barriers to therapy and helping the patient understand and navigate such barriers.
  • Serve as an educator who possesses knowledge and practical experience about clinical treatments and the strong emotions and financial implications associated with a new diagnosis, living with a chronic medical condition or life-threatening condition.
  • Enable patients by providing them with information and education about:
    • their prescribed therapy and course of treatment, fairly balanced with benefits and known side effects per manufacturer product information
    • proper administration and dosing of prescribed therapy
    • calling and working with the patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs associated with their therapy and resources for financial assistance, where applicable based upon needs communicated by the patient
    • support to help better manage the stress involved in their diagnosis.
    • Empower the patient to participate in their personal care process by triaging the patient to support for other non-program needs such as social or other intervention programs.
  • Reporting of Adverse Events/ Product Complaint received in accordance with SOP and good manufacturer practices
  • Utilize Valeris' values as the driving force behind the team's success
  • On time adherence to training deadlines for all corporate policies and procedures
  • Ensure all SOPs are followed with consistency
  • Perform additional tasks or projects as assigned

Qualifications:
  • Must have active RN licensure in current state of practice.
  • 2-3 years of nursing experience with relevant disease state experience preferred.
  • Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus.
  • Case management or Clinical Trial Nurse experience, a plus.
  • Bachelor's degree preferred.
  • Remote work eligibility is subject to all work from home criteria met and based on business need.

Physical Demands & Work Environment
  • While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
  • Although very minimal, flexibility to travel as needed is preferred.
  • This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

Why Work for Valeris?
We're committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:
  • Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
  • Additional health support, including telehealth and Employee Assistance Program (EAP) services
  • Company match on Health Savings Account contributions
  • Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
  • Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
  • 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
  • Paid Time Off (PTO) and Sick Leave to support work-life balance
  • Team members receive nine paid holidays plus two floating holidays
  • Opportunities for advancement in a company that supports personal and professional growth
  • A challenging, stimulating work environment that encourages new ideas
  • Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
  • A mission-driven, inclusive culture where your work makes a meaningful impact

Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.
Our Commitment to Equal Opportunity
At Valeris, we don't just accept difference - we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.
Important Notice
Due to an increase in hiring scams, please be aware that if you are selected to move forward in our hiring process, a member of our Talent Acquisition team will contact you directly using an official @pharmacord.com and/or @valeris.com, @echo.newtonsoftware.com email address regarding next steps in our interview process.
Please Note:
  • PharmaCord will never use Microsoft Teams to reach out to candidates for interview scheduling. However, video interviews are typically conducted via Microsoft Teams. Official meeting links will always be sent from an @valeris.com, @pharmacord.com or @echo.newtonsoftware.com email address, or through our scheduling platform, Calendly.
  • We will never request your bank account information at any stage of the hiring process.
  • We will never send a check (electronic or physical) to purchase home office equipment.

If you receive any suspicious communication regarding employment with PharmaCord, please report it to our Talent Acquisition team immediately at careers@pharmacord.com

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