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Remote Insurance Utilization Review Jobs in Massachusetts

$19.50 - $26/hr

... the insurer. * Completes medical literature searches and/or coordinates appropriate provider-to ... Case Management, Utilization Review and/or Prior Authorization experience is preferred. At Dana ...

Showing results 41-60

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 the most commonly searched types of Insurance Utilization Review jobs in Massachusetts?

The most popular types of Insurance Utilization Review jobs in Massachusetts are:

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

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

Infographic showing various Remote Insurance Utilization Review job openings in Massachusetts as of September 2026, with employment types broken down into 79% Full Time, and 21% Contract. Highlights an 100% Remote job distribution.

Licensed Independent Clinical Social Worker - Remote Position at Zenith Mind Counseling Center

Boston, MA • Remote

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 9 days ago


Job description

Position Overview

Zenith Mind Counseling Center is seeking a licensed and highly skilled Licensed Independent Clinical Social Worker (LICSW) to join our remote team. This full-time position offers the unique opportunity to work from the comfort of your home while making a significant impact on the mental health and well-being of our clients. This is a vital role that requires a proactive approach to patient care with responsibilities that encompass therapeutic support, care coordination, and collaborative planning.

About the Organization

Located in the vibrant city of Boston, Massachusetts, Zenith Mind Counseling Center specializes in providing mental health support across a broad spectrum of needs. Our mission is to foster a nurturing environment that emphasizes personal growth, healing, and empowerment for our clients. Our multidisciplinary team is dedicated to delivering compassionate and effective mental health services that are attuned to our diverse clientele, including older adults and those with complex intersecting identities.

Work Environment

As a remote employee of Zenith Mind Counseling Center, you will have the flexibility to work from home while being supported by a cohesive and collaborative team. You will engage with colleagues through virtual meetings, trainings, and team-building activities to ensure seamless communication. Despite the remote setting, we prioritize creating a sense of community and connection among our staff, as we believe that a supportive work culture directly enhances client care.

Key Responsibilities
  • Act as a liaison between clients, families, and outpatient providers, ensuring comprehensive care coordination and support.
  • Interact with insurance companies to facilitate pre-certification and manage utilization effectively, ensuring that clients receive necessary services without unnecessary delay.
  • Engage in meticulous discharge and aftercare planning, creating tailored plans that meet each client's unique needs.
  • Implement therapeutic meal support strategies, which includes modeling healthy relationships with food to aid client recovery and well-being.
  • Deliver safe, empathetic, and affirming care, adapting your approach based on clients' diverse backgrounds and specific life circumstances.
Patient Population / Client Focus

Your primary focus will be on older adults, addressing their unique mental health needs and challenges. You will work with clients who may be experiencing depression, anxiety, grief, and other mental health issues commonly faced by seniors. By applying a strengths-based perspective, you’ll contribute to fostering resilience and promoting emotional wellness in this demographic, ensuring that all interventions are considerate of their intersecting identities and cultural backgrounds.

Qualifications
  • A Master's degree in Social Work from an accredited institution.
  • A valid Licensed Independent Clinical Social Worker (LICSW) license in the state of Massachusetts.
  • Demonstrated experience working with older adults in a clinical or counseling setting.
  • Strong clinical and diagnostic skills to effectively assess the needs of clients and develop appropriate treatment plans.
  • Exceptional communication and interpersonal skills that facilitate collaborative work with clients, families, and interdisciplinary teams.
  • A demonstrated ability to work autonomously while also thriving in a team-oriented environment.
Preferred Experience
  • Previous experience in hospice care or palliative settings is highly desirable.
  • Familiarity with electronic health record (EHR) systems and documentation practices that meet regulatory standards.
  • Experience in crisis intervention and utilization of evidence-based treatment modalities.
Compensation and Benefits

The salary for this position ranges from USD 90,000 to 104,000 per year, commensurate with experience and qualifications. In addition to competitive pay, we offer a comprehensive benefits package that includes:

  • Medical, Dental, and Vision insurance options to ensure the well-being of you and your family.
  • A 401(k) plan with employer matching and flexible spending accounts to help you plan for your future.
  • Life insurance coverage providing peace of mind for you and your loved ones.
  • Accident and short-term disability insurance to protect your income during unexpected events.
Career Growth Opportunities

Zenith Mind Counseling Center is committed to your professional development. Employees have access to ongoing training and mentorship, opportunities for professional advancement, and support for continued education. You will be encouraged to pursue specialties or certifications relevant to your interests and the needs of our clientele, thereby enhancing your skills and career trajectory within the field of social work.

Why Join Our Team

Joining Zenith Mind Counseling Center means becoming part of a compassionate and dedicated team focused on making a meaningful difference in the lives of our clients. We value diversity and inclusivity, striving to create a workplace environment that reflects the rich tapestry of our community. If you are passionate about mental health care and wish to contribute to a culture of support, innovation, and quality, we would love to hear from you.

Application Information

If you are interested in applying for the Licensed Independent Clinical Social Worker position, please submit your resume and a cover letter detailing your relevant experience and your approach to working with our patient population. Applications can be sent via our careers page on the Zenith Mind Counseling Center website. We look forward to welcoming you to our team!