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Remote Insurance Utilization Review Jobs in Utah

Embedded Insurance

Licensed Insurance Agent

Park City, UT · Remote

$125K/yr

Remote Employment Type: Full-time Advertised Compensation: $60K - 125K About Embedded Insurance ... Detailed utilization of CRM to manage leads, track pipeline activity. * Adherence to all compliance ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Lehi, UT · On-site +1

$53.75 - $65.50/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

South Jordan, UT · On-site +1

$54.25 - $66.25/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

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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 popular job titles related to Remote Insurance Utilization Review jobs in Utah? For Remote Insurance Utilization Review jobs in Utah, the most frequently searched job titles are:
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What cities in Utah are hiring for Remote Insurance Utilization Review jobs? Cities in Utah with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you

Remote Part-Time Physician Advisor for Utilization Review

Medical Review Institute

Salt Lake City, UT • Remote

Part-time

This job post has expired today. Applications are no longer accepted.

Medical Review Institute of America rating

8.0

Company rating: 8.0 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

97th of 425 rated business services

Job description

A leader in clinical review services is seeking a Part-Time Physician Advisor to evaluate medical service requests and make coverage determinations. This remote role requires an active medical license, board certification in Family or Internal Medicine, and at least 5 years of patient care experience. Candidates must have strong communication skills and the ability to work independently.

The position offers flexible scheduling, with a commitment to 2 weekend shifts per month, ensuring adherence to all compliance regulations. #J-18808-Ljbffr

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