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Remote Insurance Utilization Review Jobs in Philadelphia, PA

Dane Street

Radiology - Imaging Physician

Philadelphia, PA · Remote

$322K - $403K/yr

... Record Reviews. This is a fully remote opportunity offering flexible scheduling, allowing you to ... Enhanced industry expertise in medical necessity, utilization review, and claims support * Expanded ...

MeridianLight

Be Seen First

Remote Insurance Sales (No Cold Calling, Training Provided)

Philadelphia, PA · Remote

$60K - $110K/yr

MeridianLight provides pre-set retirement review appointments with teachers and public employees ... insurance license preferred OR willing to obtain one Additional Information This is a 100% remote ...

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Remote Insurance Utilization Review information

See Philadelphia, PA salary details

$21

$42

$69

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

As of Jul 31, 2026, the average hourly pay for remote insurance utilization review in Philadelphia, PA is $42.67, according to ZipRecruiter salary data. Most workers in this role earn between $33.70 and $48.99 per hour, depending on experience, location, and employer.

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 the most commonly searched types of Insurance Utilization Review jobs in Philadelphia, PA? The most popular types of Insurance Utilization Review jobs in Philadelphia, PA are:
What are popular job titles related to Remote Insurance Utilization Review jobs in Philadelphia, PA? For Remote Insurance Utilization Review jobs in Philadelphia, PA, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Philadelphia, PA look for? The top searched job categories for Remote Insurance Utilization Review jobs in Philadelphia, PA are:
What cities near Philadelphia, PA are hiring for Remote Insurance Utilization Review jobs? Cities near Philadelphia, PA 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 Philadelphia, PA as of July 2026, with employment types broken down into 83% Full Time, and 17% Temporary. Highlights an 100% Remote job distribution, with an average salary of $88,746 per year, or $42.7 per hour.

Physician Family Practice-Without OB - Competitive Salary

Enterprise Medical Recruiting

Philadelphia, PA • On-site, Remote

$250K/yr

Other

Medical, Life, Retirement

Re-posted 15 days ago

Job description

A highly awarded health system located north of Philadelphia, Pennsylvania, is seeking a Family Medicine physician to work in a non-clinical utilization review setting.

Opportunity Highlights

  • Daytime Monday through Friday position. Potential to work remotely part of the time.
  • Strong CDI Program
  • Salary and incentive $250K+ depending upon background and experience level
  • Health, life, and disability insurance
  • 403-B Retirement Saving Plan with Employer match
  • Medical malpractice insurance and tail coverage
  • American Board of Quality Assurance and Utilization Review certification is a plus.

About Philadelphia, Pennsylvania

Famous as the birthplace of life, liberty, and the pursuit of happiness, Philadelphia delivers one destination, five counties, and countless things to do: fascinating museums, vibrant parks, national historic sites, and famous (and delicious) food.

GB-2401-97742

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