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Remote Insurance Utilization Review Jobs in New Jersey

Hurc LLC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

White Tiger Connections

Review Team Preparer

Carteret, NJ · Remote

$80K - $100K/yr

About the Role Our client is seeking a Preparer to join their Review Team, supporting nonprofit ... insurance plan (Aflac-style). * Flexible, remote schedule and a culture that values balance and ...

Manulife

$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 ...

Centerbrite

BCBA

Newark, NJ · On-site +1

$90K - $110K/yr

Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ... Remote and in-clinic Job Types: Full-time Employment Type: FULL_TIME

Centerbrite

BCBA (Part-time)

Newark, NJ · On-site +1

$90 - $110/hr

BCBA (Board Certified Behavior Analyst) - Part-time $100-110/hr Flexible Schedule Hybrid (Remote ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

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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 New Jersey?

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

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

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

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

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

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

Cities in New Jersey 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 New Jersey as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, and 4% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

Physician Advisor

Hurc LLC

Short Hills, NJ • Remote

Contractor

Re-posted 23 days ago

Job description

***WE ARE CURRENTLY FULLY STAFFED, BUT OUR NEEDS CAN CHANGE AT ANY TIME,

AND WE ARE STILL ACCEPTING APPLICATIONS***


The Physician Advisor provides physician-to-physician reviews, clinical guidance, education, and escalation support while promoting evidence-based practices and appropriate resource utilization.

Key Responsibilities

  • Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals
  • Support utilization review and case management teams with complex clinical decision-making
  • Ensure appropriate admission status determinations (inpatient vs. observation) in alignment with CMS and payer guidelines
  • Provide clinical oversight related to length of stay, care progression, and discharge planning
  • Ensure adherence to CMS Conditions of Participation, Medicare regulations, and payer policies
  • Support compliance with medical necessity criteria (InterQual, MCG, or equivalent)
  • Assist with audit preparedness and response, including RAC, MAC, and commercial payer audits
  • Partner with HIM/CDI teams to improve documentation quality and clinical accuracy


Education & Physician Engagement

  • Serve as a trusted peer resource to attending physicians and advanced practice providers
  • Educate medical staff on regulatory requirements, utilization best practices, and documentation standards
  • Support change management initiatives related to clinical operations and compliance

Qualifications


Required

  • MD or DO with an active, unrestricted medical license
  • Board-certified or board-eligible in a recognized specialty
  • Clinical practice experience in an acute care or relevant healthcare setting
  • Strong knowledge of utilization management, medical necessity, and payer regulations
  • Excellent communication skills with the ability to conduct peer-to-peer discussions


Preferred

  • Prior experience as a Physician Advisor, Medical Director, or in Utilization Review
  • Familiarity with CMS guidelines, InterQual, MCG, and denial management processes
  • Experience working with case management, CDI, HIM, or revenue cycle teams
  • Experience in a remote or consulting healthcare environment

Skills & Competencies

  • Physician-to-physician negotiation and collaboration
  • Clinical judgment balanced with regulatory and financial awareness
  • Data-driven decision-making
  • Ability to influence without authority
  • Strong written and verbal communication

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