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Remote Insurance Utilization Review Jobs in Pooler, GA

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Remote Insurance Utilization Review information

See Pooler, GA salary details

$19

$38

$62

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 Pooler, GA is $38.41, according to ZipRecruiter salary data. Most workers in this role earn between $30.34 and $44.13 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 Pooler, GA?

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

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

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

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

Cities near Pooler, GA with the most Remote Insurance Utilization Review job openings:

Remote Insurance Utilization Review jobs near you

Market Physician Executive - Float

Monogram Health

Savannah, GA • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 13 days ago

Job description

Monogram Health is seeking a mission-driven Market Physician Executive (MPE) Float to lead its in-home multi-specialty polychronic care model across an assigned region. This role involves improving the well-being, quality of life, and health outcomes for patients by overseeing clinical strategies, policies, and operations. The MPE Float will contribute to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market.

Practice Info

  • Lead an in-home multi-specialty polychronic care model in an assigned region to support all markets.
  • Each market is comprised of 5-10 practices led by local advanced practice providers (APP), registered nurses (RN), licensed clinical social workers (LCSW), and pharmacists (PharmD).
  • Collaborate with Monogram Health's Multi Specialty Platform to leverage employed specialists to deliver in-home specialty care.
  • Deploy a proven risk based model to ensure health equity and health equality leveraging proprietary next generation AI algorithms to predict the appropriate level of care.
  • Focus on improving patient experience, population health outcomes, provider satisfaction, and lowering costs.
  • Oversee the daily clinical and business operations through delivery of direct patient care, care management services, social worker support, and pharmacy services within the market.

Responsibilities

  • Know, understand, and deliver on Monogram Health's proprietary evidenced based clinical pathways.
  • Review and approve APP, RN, SW, and PharmD plans of care.
  • Overall accountability for reducing total cost of care and Medical Loss Ratio.
  • Responsible for clinical outcomes to include, but not limited to, clinical interventions closure, inpatient/outpatient utilization, pharmacological prescribing and therapy management, multi-specialty platform, and HEDIS/Gap Closure.
  • Provide direct and indirect patient care (including diagnosis and treatment of disease).
  • Engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways.
  • Provide clinical guidance and direction to Market teams to drive Population Health Management activities.
  • Participate in Monogram On-Call activities.

Compensation

  • Competitive compensation
  • 401k with employer match

Benefits

  • Medical, dental, and vision insurance
  • Employee assistance program
  • Employer-paid and voluntary life insurance
  • Disability insurance
  • Health and flexible spending accounts
  • Financial wellness resources
  • Paid holidays
  • Flexible vacation time/PSSL
  • Paid parental leave
  • Work life assistance resources
  • Physical wellness perks
  • Mental health support
  • Employee referral program
  • BenefitHub for employee discounts

Shift & Schedule

  • 7 days on call minimum once/quarter

Requirements

  • Must be willing and able to obtain hospital privileges at required facilities.
  • This position will be remote within the designated market with occasional in-home patient treatment visits and occasional domestic travel.
  • Demonstrated experience applying evidence based clinical criteria.
  • Experience in renal care and geriatrics.
  • Strong management and communication skills.
  • Active, unrestricted state medical license required in each state within the market.
  • Experience with high need Medicare Advantage and managed Medicaid populations.
  • Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
  • Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
  • Willingness to become licensed in multiple states.
  • MD or DO degree from an accredited medical school.
  • BC or BE in an ACGME approved specialty such as Nephrology, Internal Medicine, Family Practice, Emergency Medicine, Critical Care, Cardiology, Endocrinology, Hepatology, or Geriatrics.

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