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Remote Insurance Utilization Review Jobs in Pittsburgh, PA

Murtech Staffing and Solutions

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UM Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)

Pittsburgh, PA · Remote

$225K - $315K/yr

  • Medical

  • Dental

  • Vision

  • Life

Review complex utilization management cases using established medical policies and clinical ... Ability to work independently in a remote environment. Preferred Qualifications * One or more years ...

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All JobsInsurance Utilization Review JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Pittsburgh, PA

Remote Insurance Utilization Review information

See Pittsburgh, PA salary details

$20

$41

$66

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

As of Aug 12, 2026, the average hourly pay for remote insurance utilization review in Pittsburgh, PA is $41.05, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.16 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 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.
What are popular job titles related to Remote Insurance Utilization Review jobs in Pittsburgh, PA? For Remote Insurance Utilization Review jobs in Pittsburgh, PA, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Pittsburgh, PA look for? The top searched job categories for Remote Insurance Utilization Review jobs in Pittsburgh, PA are:
What cities near Pittsburgh, PA are hiring for Remote Insurance Utilization Review jobs? Cities near Pittsburgh, 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 Pittsburgh, PA as of August 2026, with employment types broken down into 67% Full Time, and 33% Contract. Highlights an 100% Remote job distribution, with an average salary of $85,380 per year, or $41 per hour.

Medical Director/Physician Reviewer

TALENT Software Services

Pittsburgh, PA • Remote

$280K - $300K/yr

Full-time

Posted 20 days ago

Job description

Position: Medical Director
Location: Remote
Duration: Contract to Hire
Working hours: Monday to Friday - 8 hours a day

Active medical state licensure required for any of these states: PA, NY, or WV.

Medical Director Job Description

This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment or service. Depending on the nature of the case, telephonic peer-to-peer discussions may be required. The incumbent ensures compliance with NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members.

Responsibilities

Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer-to-peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for members and provider determination notifications, all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise the multidisciplinary team on cases that require physician expertise.
Participate in protocol and guidelines development to ensure consistency in the review process.
Actively manage projects and/or participate on project teams that require a physician subject matter expert.
Other duties as assigned.

Required Qualifications

Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
Clinical, Direct Patient care (hospital, outpatient, or private practice)
Medical Doctor or Doctor of Osteopathic Medicine (DO)
Awarded Board Certification at least once in a specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
Case Management, Oral & Written Communication Skills, Collaboration, Listening, Telephone Skills, General Computer Skills, Clinical Software, Managed Care

Preferred Qualifications

Master's Degree in Business Administration/Management or Public Health
Medical Management in a Health Insurance Plan; strong knowledge of the managed care industry
Experience with MCG or InterQual

Company Description

A global technology organization providing enterprise hardware, infrastructure, cloud, and technology solutions to businesses worldwide.