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Remote Insurance Utilization Review Jobs in Gainesville, GA

Corvel

Indemnity Claims Specialist

Lawrenceville, GA · Remote

$52K - $85K/yr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Receives claims, confirms ... Adheres to client and carrier guidelines and participates in claims review as needed * Assists ...

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All JobsInsurance Utilization Review JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Gainesville, GA

Remote Insurance Utilization Review information

See Gainesville, GA salary details

$19

$39

$64

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

As of Aug 22, 2026, the average hourly pay for remote insurance utilization review in Gainesville, GA is $39.43, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.29 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 are popular job titles related to Remote Insurance Utilization Review jobs in Gainesville, GA?

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

What job categories do people searching Remote Insurance Utilization Review jobs in Gainesville, GA look for?

The top searched job categories for Remote Insurance Utilization Review jobs in Gainesville, GA are:

What cities near Gainesville, GA are hiring for Remote Insurance Utilization Review jobs?

Cities near Gainesville, GA 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 Gainesville, GA as of August 2026, with employment types broken down into 94% Full Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $82,006 per year, or $39.4 per hour.

Implementation Project Manager

Main Line Talent Group

Cumming, GA • Remote

$100K - $125K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago

Job description

This is a remote position.

Implementation Project Manager, North America

Location: United States (remote, in-region), with travel to client sites across North America Reports to: Head of Delivery, North America Function: Operations, Delivery

About Our Client

Our client builds shop-floor software for mid-market manufacturers, combining warehouse management, manufacturing execution, and transport management in one configurable system, for companies that find larger ERP platforms too expensive and too complex. The company operates across South Africa, the United Kingdom, and North America, with deep ties to a leading mid-market ERP channel and a growing presence in the Acumatica ecosystem.

Job Description

The Implementation Project Manager owns the schedule, milestones, and client relationship on North American implementations. Larger US builds are configured by a team in South Africa (six hours ahead), while other builds are delivered in-region, and this role manages the schedule locally across both. The position runs projects end to end, from intake through the handover gate, and coordinates closely with the international project office on methodology while keeping US priorities and workload managed locally.

This is a billable role: project management time is charged to the client project, so the position carries a utilization target alongside its delivery measures. Because of the time difference with South Africa, an earlier start (around 7:00 AM ET) is needed on occasion.

Key Responsibilities
  • Set up new US projects against the standard: confirm sizing and category, establish the baseline plan, and secure offshore configuration capacity ahead of need
  • Track schedule and milestones against baseline, catch slippage early, and re-plan when needed
  • Serve as the client's point of contact on timing, sequencing, and client-side deliverables
  • Coordinate with the offshore configuration team on assigned US builds
  • Document, price, and route scope changes rather than absorbing them into the plan
  • Identify and escalate project risks early
  • Manage each project through closure: open issues resolved, support briefed, documentation complete


Requirements
  • 5+ years managing software implementation projects with external clients, owning both schedule and client relationship
  • Experience with multi-site or phased rollouts
  • Comfortable holding clients to commitments, including delivering hard news early without damaging the relationship
  • Experience carrying a billable utilization target alongside delivery work
  • Based in the United States, able to travel to client sites across North America

Preferred:

  • PMP or equivalent certification
  • Experience managing projects with a build team in another country or time zone
  • Manufacturing, warehousing, or distribution industry experience
  • ERP implementation experience, particularly SYSPRO
  • Experience with Microsoft Dynamics Project Operations or similar PSA tools


Benefits

This role comes with a comprehensive benefits package, including:

  • Medical, dental, and vision coverage, with employee-only medical coverage at zero cost and a company HSA contribution for employees on the medical plan
  • 401(k) with a dollar-for-dollar company match up to 6%, immediate full vesting, and company-paid plan administrative fees
  • Flexible PTO, accruing up to 120 hours (15 days) annually, plus 7 paid company holidays
  • Voluntary benefits available through payroll deduction, including short- and long-term disability, supplemental life/ADD, accident and critical illness insurance, pre-paid legal, telemedicine, and identity protection