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Remote Insurance Utilization Review Jobs in Nevada

Deloitte

Epic Denials Management Operator

Las Vegas, NV · Remote

$17.25 - $23/hr

This is a primarily remote role supporting enterprise Epic support, with minimal travel and ... Review hospital account records and payer remittance records, communicate with relevant Client RCM ...

UHS

Accounts Receivable Specialist- Remote

Reno, NV · On-site +1

$19.14 - $28.72/hr

Meets routinely with Supervisor to review productivity results and understands best practices and ... insurances, claim submission requirements, reimbursement guidelines, and denial reason codes

AmeriSave Mortgage Corp.

$100K/yr

Benefits: · 401(k) · Dental insurance · Disability insurance · Employee discounts · Health ... reviewed here: www.amerisave.com/privacy-policy AmeriSave Mortgage Corporation's California ...

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

Remote Insurance Utilization Review 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.

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 popular job titles related to Remote Insurance Utilization Review jobs in Nevada? For Remote Insurance Utilization Review jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Nevada look for? The top searched job categories for Remote Insurance Utilization Review jobs in Nevada are:
What cities in Nevada are hiring for Remote Insurance Utilization Review jobs? Cities in Nevada 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 Nevada as of August 2026, with employment types broken down into 92% Full Time, 2% Part Time, and 6% Contract. Highlights an 100% Remote job distribution.

Coder II - Remote

The Center for Orthopedic and Research E

Reno, NV • Remote

$18.75 - $25/hr

Full-time

Re-posted 3 days ago

Job description

ESSENTIAL FUNCTIONS

  • Abstracts data in compliance with national, regional, and local policies, and interprets and reviews medical record documentation to assign accurate ICD-10 diagnosis and CPT procedure codes.
  • Utilizes practice management system (PMS) to accurately account for demographics and services performed for all scheduled and unscheduled surgical cases according to standard procedures and coding guidelines.
  • Utilizes individual hospital medical record systems and coordinates with physicians and staff to obtain clinical documents and demographics required for appropriate coding and billing for all hospital procedures.
  • Provides education and support to clinical areas regarding appropriate documentation and coding of services to achieve accurate billing. Maintains effective communication with providers concerning coding issues.

EDUCATION

  • High school diploma/GED or equivalent working knowledge preferred.
  • Accredited by the American Health Information Management Association (CCS-P) or the American Academy of Professional Coders (CPC).

EXPERIENCE

  • At least three years of experience in provider coding and medical terminology with extensive knowledge of ICD-10, CPT, and HCPC coding required.
  • Preferred specialty experience in areas of Orthopedics, Neurology, Physical Medicine, and Rehabilitation or Pain Management.

REQUIREMENTS

  • A minimum of one of the following credentials: CCS-P or CPC.
  • Meets established coding and abstracting quality and productivity standards.
  • Experience with various coding software. Previous experience with remote coding is preferred. Possesses PC skills, both keyboarding and applications.
  • Requires a good understanding of anatomy, physiology, medical terminology, and disease processes.
  • Ability to work independently.
  • Excellent attention to details.

KNOWLEDGE

  • Demonstrates knowledge of sequencing diagnoses and procedure codes outlined in the ICD-10-CM Official Coding Guidelines, Uniform Hospital Discharge Data Set, CMS guidelines, and other resources as applicable.
  • Knowledge of government and commercial insurance plans requirements.
  • Understands and applies medical terminology, anatomy, physiology, surgical technology, pharmacology, and disease processes.

SKILLS

  • Skill in customer service and an understanding of The HOPCo code of conduct and culture.
  • Skill in communicating effectively with physicians, clinical staff, and the public.
  • Skill in establishing good working relationships with both internal and external customers.

ABILITIES

  • Ability to maintain patient confidentiality.
  • Ability to communicate with internal and external customers professionally.
  • Ability to work independently.

ENVIRONMENTAL WORKING CONDITIONS

  • Normal office environment.

PHYSICAL/MENTAL DEMANDS

  • Requires sitting and standing associated with a normal office environment.
  • Some bending and stretching are required.
  • Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS

  • HOPCo Mission, Vision, and Values must be read and signed.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.