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Remote Insurance Utilization Review Jobs in Montclair, NJ

HURC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

Hurc LLC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

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All JobsInsurance Utilization Review JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Montclair, NJ

Remote Insurance Utilization Review information

See Montclair, NJ salary details

$21

$43

$70

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

As of Aug 20, 2026, the average hourly pay for remote insurance utilization review in Montclair, NJ is $43.09, according to ZipRecruiter salary data. Most workers in this role earn between $34.04 and $49.47 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 Montclair, NJ look for?

The top searched job categories for Remote Insurance Utilization Review jobs in Montclair, NJ are:

What cities near Montclair, NJ are hiring for Remote Insurance Utilization Review jobs?

Cities near Montclair, NJ with the most Remote Insurance Utilization Review job openings:

Remote Insurance Utilization Review jobs near you

*REMOTE* Orthopedic Surgeon (Non Spine) Hand Peer Reviewers

Provider Resources, LLC

New York, NY • Remote

Other

Re-posted 5 days ago

Job description

Provider Resources, LLC (PRI) is seeking board-certified clinicians to join our panel for an important mission of ensuring quality healthcare for our Nation’s Veterans.
As a VA medical reviewer, you will conduct thorough, objective case reviews to assess the quality and appropriateness of care provided to Veterans. This is a remote, flexible position that allows you to contribute your clinical expertise while maintaining your current practice.
What Should I Expect?
  • Performs comprehensive medical record peer reviews for determination of appropriate clinical outcomes in accordance with all State and Federal mandated regulations
  • Make clinical judgments based on clinical experience and evidence-based medical research as a Subject Matter Expert (SME) in your clinical area of expertise
  • Maintain compliance with all regulation changes as they impact medical and utilization review practices
  • Document all review information as instructed
  • Communicate report results to the appropriate supervisor
  • Access electronic health information, as assigned/granted
Do I Qualify?
  • Must hold a current medical license
  • Must be board certified within their clinical specialty (as appropriate)
  • Currently works a minimum of 20 hours per month within their area of clinical specialty
  • Must have a minimum of 5 years full-time experience in direct care
  • Must be actively seeing patients within the last 3 years
Website: https://www.provider-resources.com/vareviews • Email: pripanel@provider-resources.com

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