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Remote Insurance Utilization Review Jobs in Circle Pines, MN

Allianz

Counsel | Remote

Minneapolis, MN · On-site +1

S. legacy insurance liabilities. It services Allianz Group affiliates and third parties including ... Responsibilities includes preparation, review and negotiation of prospective reinsurance term ...

ResMed

Review Specialist, OASIS & 485

Bloomington, MN · Remote

$62K - $80K/yr

OASIS Review Coding Specialist This is a remote position that provides flexibility and control over ... Must comprehend the basics of home health and hospice business operations, insurance claims ...

MatrixCare

Review Specialist, OASIS & 485

Bloomington, MN · Remote

$62K - $80K/yr

OASIS Review Coding Specialist This is a remote position that provides flexibility and control over ... Must comprehend the basics of home health and hospice business operations, insurance claims ...

Resmed

Review Specialist, OASIS & 485

Bloomington, MN · Remote

$62K - $80K/yr

OASIS Review Coding Specialist This is a remote position that provides flexibility and control over ... Must comprehend the basics of home health and hospice business operations, insurance claims ...

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All JobsInsurance Utilization Review JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Circle Pines, MN

Remote Insurance Utilization Review information

See Circle Pines, MN salary details

$20

$41

$67

How much do remote insurance utilization review jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for remote insurance utilization review in Circle Pines, MN is $41.50, according to ZipRecruiter salary data. Most workers in this role earn between $32.79 and $47.64 per hour, depending on experience, location, and employer.

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 job categories do people searching Remote Insurance Utilization Review jobs in Circle Pines, MN look for?

The top searched job categories for Remote Insurance Utilization Review jobs in Circle Pines, MN are:

What cities near Circle Pines, MN are hiring for Remote Insurance Utilization Review jobs?

Cities near Circle Pines, MN with the most Remote Insurance Utilization Review job openings:

Remote Insurance Utilization Review jobs near you

Behavioral Health Utilization Management Clinician

Minneapolis, MN • Remote

Adecco
Recruiting and Staffing Services • 10K+ employees
Learn more about Adeccoexternal

$39 - $41.40/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description

Adecco Healthcare & Life Sciences is currently hiring a Behavioral Health Utilization Management Clinician for a remote telecommute opportunity in Nevada.

This is a remote opportunity with a Monday–Friday schedule.

Please review the details below and apply with an updated resume for consideration.

Position Details:

· Pay: $39 to $41.40/hour

· Contract: Four to Six-Contract, possibility of extension or becoming permanent

· Location: Remote / Telecommute

· Schedule: Monday–Friday, 8:00 AM–5:00 PM PST

Primary Responsibilities:

· Review outpatient ABA requests for medical necessity using established clinical criteria, including MCG, InterQual, ASAM, and plan-specific guidelines.

· Evaluate treatment plans, progress reports, assessments, and supporting documentation submitted by providers.

· Collaborate with providers to clarify documentation and ensure the appropriate level of care.

· Make determinations or recommendations for approval, modification, or denial of services.

· Document clinical decisions and rationale accurately in the utilization management system.

· Review clinical information and apply established guidelines to support appropriate behavioral health services.

· Manage multiple cases in a high-volume, deadline-driven environment.

· Collaborate with internal clinical and administrative teams to support quality patient care.

Qualifications:

· BCBA, LBA, RN, Master's degree in Social Work, or related behavioral health field.

· LCSW, LPC, LMFT, or equivalent behavioral health credentials accepted.

· Active, unrestricted behavioral health license in the State of Nevada preferred.

· Minimum of 2 years of behavioral health clinical experience, including ABA experience.

· Familiarity with Medicaid and commercial benefit structures and utilization management protocols.

· Experience reviewing clinical documentation and determining medical necessity.

· Ability to work independently and effectively within a remote team environment.

· Proficiency with clinical systems, Microsoft Office applications, and electronic documentation platforms.

· Strong ability to multitask and meet deadlines in a high-volume environment.

· Experience in behavioral health utilization management or prior authorization.

Why Work for Adecco?

· Excellent Weekly Pay

· 401(k) Plan

· Skills Training

· Medical, Dental, and Vision Benefits


Pay Details: $39.00 to $41.40 per hour
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
Military connected talent encouraged to apply
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
  • The California Fair Chance Act
  • Los Angeles City Fair Chance Ordinance
  • Los Angeles County Fair Chance Ordinance for Employers
  • San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.