In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
Director of Utilization Management
Troy, MI · On-site +1
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Company-paid life insurance * Company-paid short term disability coverage (location restrictions ...
Director of Utilization Management
Troy, MI · On-site +1
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Company-paid life insurance * Company-paid short term disability coverage (location restrictions ...
Support insurance authorization reviews and documentation standards * Assist with internal clinical ... Remote work opportunity * Health, dental, and vision insurance * Paid Time Off * Paid holidays ...
Quick apply
Support insurance authorization reviews and documentation standards * Assist with internal clinical ... Remote work opportunity * Health, dental, and vision insurance * Paid Time Off * Paid holidays ...
Insurance Specialist
Boyne City, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Boyne City, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Dearborn, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Dearborn, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Warren, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Warren, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
West Branch, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
West Branch, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Farmington Hills, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Farmington Hills, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Flint, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Flint, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Ann Arbor, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Ann Arbor, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Cass City, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Specialist
Cass City, MI · Remote
$20 - $35/hr
Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...
Insurance Sales Representative (Remote)
Grand Rapids, MI · On-site +1
$10K - $20K/wk
Set appointments and review their needs * Present coverage options (virtual or in-person) * Help ... Fully remote, flexible work environment * Growth-focused culture with advancement opportunities ...
Insurance Sales Representative (Remote)
Grand Rapids, MI · On-site +1
$10K - $20K/wk
Set appointments and review their needs * Present coverage options (virtual or in-person) * Help ... Fully remote, flexible work environment * Growth-focused culture with advancement opportunities ...
Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements ... CSAA Insurance Group is an equal opportunity employer. #li-ml1 . The national average salary range ...
Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements ... CSAA Insurance Group is an equal opportunity employer. #li-ml1 . The national average salary range ...
Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements ... CSAA Insurance Group is an equal opportunity employer. #li-ml1 . The national average salary range ...
Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements ... CSAA Insurance Group is an equal opportunity employer. #li-ml1 . The national average salary range ...
$73K - $122K/yr
Strong understanding of annuity and life insurance products, including their features, benefits ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
$73K - $122K/yr
Strong understanding of annuity and life insurance products, including their features, benefits ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Suitability Review Specialist
Wyoming, MI · Remote
$73K - $122K/yr
Strong understanding of annuity and life insurance products, including their features, benefits ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Suitability Review Specialist
Wyoming, MI · Remote
$73K - $122K/yr
Strong understanding of annuity and life insurance products, including their features, benefits ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties Performs audits in utilization management, care management, member assessment ...
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties Performs audits in utilization management, care management, member assessment ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · Remote
$26.41 - $51.49/hr
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · Remote
$26.41 - $51.49/hr
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Remote Insurance Utilization Review information
What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?
| Aspect | Remote Insurance Utilization Review | Remote Claims Reviewer |
|---|---|---|
| Credentials | Typically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professional | Usually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H |
| Work Environment | Remote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of services | Remote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance |
| Industry Usage | Commonly used in healthcare insurance to evaluate medical necessity | Used 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 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.
What are the most commonly searched types of Insurance Utilization Review jobs in Michigan? The most popular types of Insurance Utilization Review jobs in Michigan are:
What are popular job titles related to Remote Insurance Utilization Review jobs in Michigan? For Remote Insurance Utilization Review jobs in Michigan, the most frequently searched job titles are:
- Full Time Physician Advisor Utilization Review
- No Experience Utilization Review Nurse
- Remote Cvs Utilization Management Nurse
- Evening Utilization Review Nurse
- Flex Schedule Remote Utilization Review Nurse
- Registered Nurse Utilization Review
- Seasonal Remote Hedis Review Nurse
- Utilization Review Nurse
- Remote Utilization Management Nurse
- Weekend Physician Advisor Utilization Review
What job categories do people searching Remote Insurance Utilization Review jobs in Michigan look for? The top searched job categories for Remote Insurance Utilization Review jobs in Michigan are:
- Optum Utilization Review Nurse
- Registered Nurse Case Review
- Remote Weekend Utilization Review
- Authorization Utilization Review
- Remote Navihealth Utilization Review
- Remote Aetna Utilization Review Nurse
- From Home International Utilization Review Nurse
- Lpn Utilization Review
- From Home Anthem Utilization Review Nurse
- Temporary Aetna Utilization Review Nurse
What cities in Michigan are hiring for Remote Insurance Utilization Review jobs? Cities in Michigan with the most Remote Insurance Utilization Review job openings:
Full-time
Re-posted 14 days ago
Job description
In this position you will be reviewing patient charts to determine if pre-elective surgical cases should be boarded as inpatient instead of outpatient. You will also review the CPTs that were boarded for meeting inpatient on the CMS inpatient list and the InterQual inpatient list based on payer criteria used.
Hours are Monday - Friday from 830am until 5pm with no weekends
EDUCATION AND EXPERIENCE:
- RHIT, RHIA, or related coding certification required.
- Minimum 3-5 years of clinical experience preferred.
- Previous utilization management or case management experience preferred.
CERTIFICATIONS/LICENSURES REQUIRED:
- RHIT, RHIA, or related coding certification required.
Additional Information
- Organization: Corporate Services
- Department: Central Utilization Mgt
- Shift: Day Job
- Union Code: Not Applicable