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Remote Insurance Utilization Review Jobs in Ohio

SPECIALTY RX, Inc.

Remote Pharmacist

Columbus, OH · On-site +1

$58 - $60/hr

Review, verify, and approve high-volume medication orders for long-term care residents. * Perform ... Group Life Insurance and Short-Term Disability. * Paid time off and paid holidays. * 401(k) with ...

SpecialtyRx, Inc.

Remote Pharmacist

Columbus, OH · Remote

$56.25 - $67.50/hr

Review, verify, and approve high-volume medication orders for long-term care residents. * Perform ... Group Life Insurance and Short-Term Disability. * Paid time off and paid holidays. * 401(k) with ...

Little Acorn ABA

BCBA-remote

Cleveland, OH · Remote

$70K - $85K/yr

Review data and make clinically appropriate adjustments to treatment plans as needed. * Provide ... Ensure documentation is timely, accurate, and compliant with regulatory, insurance, and ...

Huntington

Insurance Surety Account Manager

Toledo, OH · On-site +1

Review and present carrier quotes, ensuring alignment with client needs and agency standards ... Remote roles will also have the opportunity to come together in our offices for moments that matter.

Huntington

Insurance Surety Account Manager

Toledo, OH · On-site +1

Review and present carrier quotes, ensuring alignment with client needs and agency standards ... Remote roles will also have the opportunity to come together in our offices for moments that matter.

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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 popular job titles related to Remote Insurance Utilization Review jobs in Ohio?

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

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

The top searched job categories for Remote 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:

Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Ohio as of September 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, and 5% Contract. Highlights an 84% Physical, 1% Hybrid, and 15% Remote job distribution.

Remote Pharmacist

Columbus, OH • On-site, Remote

SPECIALTY RX, Inc.
See more jobs at SPECIALTY RX, Inc.external

$58 - $60/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 1 hour ago

Key responsibilities

  • Review, verify, and approve high-volume medication orders for long-term care residents.

  • Perform outbound and inbound calls to clarify and resolve order issues with healthcare staff and facility personnel.

  • Evaluate medication orders for appropriateness, regulatory compliance, and document all interventions within the pharmacy system.

Job description

Description
MUST BE LOCATED IN OHIO AND LICENSES IN OH AND KY.
Competitive Pay | Stable Schedule | Career Growth:
We are a long-term care pharmacy providing pharmaceutical services to skilled nursing facilities and assisted living communities across multiple states. We are committed to delivering accurate, timely, and patient-centered pharmacy services through advanced technology, strong clinical oversight, and a collaborative healthcare approach.
Position Summary:
This is a remote, verification-focused pharmacist role responsible for reviewing and verifying medication orders for long-term care facilities, handling inbound and outbound clarification calls, and ensuring all orders meet clinical, regulatory, and operational standards. This role is production-driven and requires strong clinical judgment, efficiency, and excellent communication skills in a fast-paced remote environment.
Key Responsibilities:
  • Review, verify, and approve high-volume medication orders for long-term care residents.
  • Perform outbound clarification calls to nursing staff, physicians, and facility personnel as needed.
  • Receive and manage inbound calls related to order issues and clarifications.
  • Evaluate medication orders for appropriateness of drug, dose, route, frequency, interactions, and regulatory compliance.
  • Accurately document all interventions, clarifications, and communications within the pharmacy system.
  • Triage STAT orders and new admissions to ensure timely turnaround.
  • Apply all applicable state and federal pharmacy regulations related to long-term care operations.
  • Collaborate with on-site pharmacy teams to resolve order discrepancies and workflow issues.
  • Maintain strict HIPAA compliance and patient confidentiality at all times.
  • Meet productivity, accuracy, and quality benchmarks.

Remote & Technical Requirements:
  • Secure, HIPAA-compliant home workspace.
  • Reliable high-speed internet connection.
  • Ability to work independently in a structured, production-driven environment.
  • Comfort using ECM, Framework, and VOIP/multi-line phone systems.
  • Dual monitors and headset strongly recommended for efficiency.

Qualifications:
  • Active Pharmacist License in the State of Ohio & Kentucky Required.
  • Located within Region; OH.
  • Previous long-term care pharmacy experience strongly preferred.
  • Experience in high-volume order verification environments preferred.
  • Strong analytical, clinical judgment, and critical thinking skills.
  • Excellent verbal and written communication skills.
  • High attention to detail and accuracy.
  • Strong organizational and multitasking abilities.
  • Proficiency with pharmacy systems and computer-based workflows.

Schedule Requirements:
    • 6pm-2:30am
    • 4pm-12:30am
    • Monday- Friday and Every other weekend rotation is required.
    • Holiday coverage is required.

What We Offer:
  • Competitive pay (based on experience).
  • Health, dental, and vision insurance.
  • Group Life Insurance and Short-Term Disability.
  • Paid time off and paid holidays.
  • 401(k) with company match.
  • Paid training.
  • Advancement opportunities.

About SpecialtyRx:
SpecialtyRx is proud to be a beacon for inclusion, collaboration and diversity. Everyone cares in the same language, and we draw from each community to be for each community.

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