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Remote Insurance Utilization Review Jobs in Ohio

Virtual Group Therapist

Toledo, OH · On-site +1

$401K/yr

... reviews, utilization management processes, and coordination of care with insurance providers and interdisciplinary treatment teams. * Competency in crisis intervention, de-escalation techniques ...

Remote Sales

Akron, OH · 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 ...

This role is responsible for reviewing 811 locate tickets to ensure accurate status coding, proper ... insurance • Short- and long-term disability coverage • Flexible benefits plan • 401(k) with ...

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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 are remote insurance utilization review jobs?

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 are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

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 Ohio? The most popular types of Insurance Utilization Review jobs in Ohio are:
What cities in Ohio are hiring for Remote Insurance Utilization Review jobs? Cities in Ohio with the most Remote Insurance Utilization Review job openings:

Credit Review Specialist - Commercial

Huntington

Cleveland, OH • On-site, Remote

$63K - $124K/yr

Full-time

Medical, Life, Retirement, PTO

Posted 19 days ago


Job description

Description

Summary:

The Credit Review Specialist (CRS) - Commercial will report to a Commercial Credit Review Team Lead and perform activities to evaluate the credit risk embedded in Bank assets. The candidate will possess an exceptional delivery track record in Commercial banking and conduct portfolio management and credit risk continuous monitoring activities associated with a strong independent Credit Review function.Primary responsibilities include continuous assessment of the adequacy of portfolio management and credit risk monitoring activities performed by the commercial lines of business, aggregation of observations in contribution to a report of actionable recommendations, and various other data testing and analysis in support of exams and/or finding validation exercises.

Duties and Responsibilities:

  • Review, analyze, and assess commercial loans to determine adequacy of credit process, portfolio management and credit risk monitoring activities including but not limited to (a) timeliness of customer reporting receipt and review, (b) timeliness of risk ratings, (c) appropriateness of credit approval authority, (d) accuracy of loan documents, and (e) accuracy of reported obligor/obligation risk rating and other classifications.
  • Participate in the annual review of commercial credit processes for financial statement spreading and lien perfection and contribute to a report of actionable recommendations.
  • Conduct testing for validation of Credit Review issued findings.
  • Effectively communicate and interface with Credit Review colleagues, business segment and credit support constituent colleagues, and other Risk Management colleagues.Communicate information by composing memos, reports, and correspondence to colleagues.
  • Manage multiple engagements/projects simultaneously.
  • Perform other Credit Review continuous monitoring and/or targeted exam duties as assigned.
  • Performs other duties as assigned.

Basic Qualifications:

  • Bachelor's degree
  • 3+ years of experience in Commercial banking
  • Working knowledge of MS Excel, Word and PowerPoint
  • Strong written and verbal communication skills

Preferred Qualifications:

  • 3+ years of experience in Commercial portfolio management/underwriting and/or risk management
  • Preferred degrees: Accounting, Finance, Economics, Business
  • Technical accounting (GAAP) or financial statement analysis knowledge

#LI-RP1


Exempt Status: (Yes= not eligible for overtime pay) (No= eligible for overtime pay)

Yes

Workplace Type:

Office

Our Approach to Office Workplace Type

Certain positions outside our branch network may be eligible for a flexible work arrangement. We're combining the best of both worlds: in-office and work from home. Our approach enables our teams to deepen connections, maintain a strong community, and do their best work. Remote roles will also have the opportunity to come together in our offices for moments that matter. Specific work arrangements will be provided by the hiring team.

Huntington will not sponsor applicants for this position for immigration benefits, including but not limited to assisting with obtaining work permission for F-1 students, H-1B professionals, O-1 workers, TN workers, E-3 workers, among other immigration statuses. Applicants must be currently authorized to work in the United States on a full-time basis.

Compensation Range:

$63,000-$124,000 Annual Salary

The compensation range represents the anticipated low and high end of the base compensation range for this position. Actual compensation will vary based on various factors including but not limited to location, experience, and education. Colleagues in this position are also eligible to participate in an applicable incentive compensation plan. In addition, Huntington provides a variety of benefits to colleagues, including health insurance coverage, wellness program, life and disability insurance, retirement savings plan, paid leave programs, paid holidays and paid time off (PTO).

Huntington is an Equal Opportunity Employer.

Tobacco-Free Hiring Practice: Visit Huntington's Career Web Site for more details.

Note to Agency Recruiters: Huntington will not pay a fee for any placement resulting from the receipt of an unsolicited resume. All unsolicited resumes sent to any Huntington colleagues, directly or indirectly, will be considered Huntington property. Recruiting agencies must have a valid, written and fully executed Master Service Agreement and Statement of Work for consideration.