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Remote Insurance Utilization Review Jobs in New York

CVS Health

Utilization Management Nurse Consultant

New York, NY · Remote

$32.01 - $68.55/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

UM Nurse Consultant Fully Remote- WFH Schedule - 4x10's- Thursday, Saturday, Sunday, Monday 8A-7P ... utilization Consults and lends expertise to other internal and external constituents in the ...

MedReview

Physician Reviewer

Manhattan, NY · On-site +1

This is a fully remote opportunity for a physician with a strong background in utilization review and clinical validation who thrives in a fast-paced, data-driven environment. In this role, you will ...

MedReview

Physician Reviewer

Manhattan, NY · Remote

This is a fully remote opportunity for a physician with a strong background in utilization review and clinical validation who thrives in a fast-paced, data-driven environment. In this role, you will ...

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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 York?

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

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

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

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

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

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

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

Remote Insurance Utilization Review jobs near you

Physician Reviewer - Psychiatry (Utilization Review)

Dane Street, LLC

New York, NY • Remote

Contractor

Re-posted 2 days ago

Job description

Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-Certified Psychiatrist with an active New York medical license and Workers’ Compensation Board Certification to conduct Utilization Reviews.

This is a fully remote, non-clinical role offering supplemental income with flexible scheduling. Physicians provide objective, evidence-based opinions on the medical necessity of treatment requests and appeals. No patient contact, no treatment, and no doctor-patient relationship is established.

Key Responsibilities:

  • Review medical records to determine the medical necessity of services
  • Utilize state-specific workers’ compensation guidelines and nationally recognized criteria
  • Submit clear, concise, and well-supported determinations
  • Complete reviews within required timeframes (typically 1–5 business days)
  • Participate in peer-to-peer calls as needed (coordinated by Dane Street)
  • Complete addenda when new information is provided

Role Highlights:

  • Independent contractor (1099) status
  • Average case takes 15 minutes or less
  • Flat rate per case – consistent, supplemental income
  • Fully remote – work from anywhere
  • You control volume and availability
  • No direct patient interaction or treatment
  • Chronological, pre-organized medical records provided
  • User-friendly portal and streamlined case management
  • Full onboarding and ongoing support included

Requirements:

  • Board Certification in Psychiatry
  • Active, unrestricted New York medical license
  • Workers’ Compensation Board Certification (New York)
  • Active clinical practice

About Dane Street:
Dane Street is a national leader in Utilization Review and Independent Medical Review services. We partner with highly qualified, actively practicing physicians to ensure high-quality, evidence-based clinical decisions that support better outcomes across the healthcare system.

Apply today to join our Physician Review Panel and start earning on your schedule.