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Remote Insurance Utilization Review Jobs in Virginia

Clarest Health

Account Manager (Remote Eligible)

Vienna, VA · Remote

$86K - $138K/yr

Up to 20% What We Offer: · Comprehensive Medical, Dental and Vision Insurance (as low as $13.73 ... Tracks utilization, service adoption, and client feedback; flags issues early and addresses routine ...

Clarest Health

Account Manager (Remote Eligible)

Vienna, VA · On-site +1

$86K - $138K/yr

Up to 20% What We Offer: • Comprehensive Medical, Dental and Vision Insurance (as low as $13.73 ... Tracks utilization, service adoption, and client feedback; flags issues early and addresses routine ...

Guidehouse

Loan Review Senior Consultant

Mclean, VA · On-site +1

$98K - $163K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

Guidehouse

Loan Review Senior Consultant

Mclean, VA · On-site +1

$98K - $163K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

Guidehouse

Loan Review Managing Consultant

Mclean, VA · On-site +1

$113K - $188K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

Guidehouse

Loan Review Managing Consultant

Mclean, VA · On-site +1

$113K - $188K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

ICF

Enterprise Architect (Remote) NI

Reston, VA · On-site +1

$71.75 - $92.50/hr

Advisory & Governance Reviews * Provide strategic technical advisory services to programs and ... utilization. Business Product Management * Ensure customer and program needs are met through ...

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All JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Virginia

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 Virginia? For Remote Insurance Utilization Review jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Virginia look for? The top searched job categories for Remote Insurance Utilization Review jobs in Virginia are:
What cities in Virginia are hiring for Remote Insurance Utilization Review jobs? Cities in Virginia with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
Medical Insurance Speicalist-REMOTE

Medical Insurance Speicalist-REMOTE

The US Oncology Network

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 14 days ago

US Oncology rating

7.4

Company rating: 7.4 out of 10

Based on 104 frontline employees who took The Breakroom Quiz

250th of 870 rated healthcare providers

Job description

Overview
Employment Type: Full Time
REMOTE
Benefits: M/D/V, Life Ins., 401(k)
Norfolk, Virginia
SCOPE: With minimal supervision, is responsible for payer and patient account balances being paid timely and remaining current. Performs collection activities such as monitoring delinquent accounts, contacting patients for account payment, resolving billing problems, and answering routine to complex account inquiries. Performs responsibilities within standard procedures and pre-established guidelines to complete tasks. A certain degree of creativity and latitude is required. Supports and adheres to The US Oncology's Compliance Program, to include the Code of Ethics and Business Standards, and The US Oncology's Shared Values
The US Oncology Network is a thriving organization that fosters forward-thinking, advancement opportunities, and an inspired work environment. We continuously look for top talent who will continue to propel our organization in the right direction and celebrate new successes! Come join our team in the fight against cancer!
About US Oncology
The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care. For more information, visit www.usoncology.com. We extend an extremely competitive offering of benefits to employees, including Medical Health Care, Dental Care, Vision Plan, 401-K with a matching component, Life Insurance, Short-term and Long-term disability, and Wellness & Perks Programs.
Responsibilities
ESSENTIAL DUTIES AND RESPONSIBILITIES
• Monitors delinquent accounts and performs collection duties
• Reviews reports, researches and resolves issues
• Reviews payment postings for accuracy and to ensure account balances are current
• Works with co-workers to resolve insurance payment and billing errors
• Monitors and updates delinquent accounts status
• Recommends accounts for collection or write-off
• Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations.
• Answers patient payment, billing, and insurance questions and resolves complaints.
• Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations
• Answers patient payment, billing, and insurance questions and resolves complaints
• May refer patients to Patient Benefits Representative to set up payment plans
• Maintains credit balances of patients and payors ensuring timely refunds within government guidelines/regulations
• Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regard to patient records
• Performs other duties as requested or assigned
Qualifications
MINIMUM QUALIFICATIONS
• High School diploma or equivalent required
• Minimum two (2) years combined medical billing and payment experience required
• Demonstrate knowledge of state, federal, and third party claims processing required
• Demonstrate knowledge of state & federal collections guidelines
• Must successfully complete required e-learning courses within 90 days of occupying position
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
WORK ENVIRONMENT: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.

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