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Remote Insurance Utilization Review Jobs in Raleigh, NC

Prosperity Home Mortgage

Closer - Remote

Raleigh, NC · Remote

Ensure accuracy of tax/insurance information and data entry. * Ensure disclosure timing ... Review documents for completeness and request additional information as required. * Resolve defects ...

Spieldenner Financial Group

Sales Associate (Remote)

Durham, NC · On-site +1

$13.50 - $18.25/hr

Preparation & Research (4-5 hrs/week) Review client information and prepare personalized coverage ... Light Admin (2 hrs/week) Follow up on applications and communicate with insurance carriers as ...

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All JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Raleigh, NC

Remote Insurance Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

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

As of Jun 15, 2026, the average hourly pay for remote insurance utilization review in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 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 Raleigh, NC? The most popular types of Insurance Utilization Review jobs in Raleigh, NC are:
What are popular job titles related to Remote Insurance Utilization Review jobs in Raleigh, NC? For Remote Insurance Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Raleigh, NC look for? The top searched job categories for Remote Insurance Utilization Review jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Remote Insurance Utilization Review jobs? Cities near Raleigh, NC with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you

Remote Board Certified Behavior Analyst (NJ LBA Required)

Social Circle ABA

Raleigh, NC • Remote

$55 - $65/hr

Part-time

Posted 3 days ago

Job description

Job Type: Full-Time / Part-Time (100% Remote) Salary: $55.00 - $65.00 per hour (Depending on experience and caseload availability)

About the Role: Are you an out-of-state BCBA looking to leverage your credentials for a high-paying, fully remote role? We are seeking dedicated, high-caliber Board Certified Behavior Analysts (BCBAs) to provide top-tier remote clinical oversight, programming, and telehealth supervision for our clients in the Passaic, New Jersey area.

Enjoy the complete flexibility of working 100% from home while earning a premium hourly rate that exceeds your local market standard.

Please Note: Because our clients are located in New Jersey, candidates MUST hold an active New Jersey Licensed Behavior Analyst (LBA) credential in good standing at the time of application.

Key Responsibilities:

  • Conduct remote clinical assessments, intake reviews, and design comprehensive, individualized behavior intervention plans (BIPs).

  • Provide high-quality remote supervision, mentorship, and support to our on-the-ground Registered Behavior Technicians (RBTs).

  • Review clinical data regularly through our practice management platform to modify programming and ensure steady client progress.

  • Conduct regular telehealth caregiver training and family collaboration sessions to promote generalization of skills.

  • Ensure all clinical documentation, progress notes, and authorization reports meet rigorous insurance billing requirements and compliance guidelines.

What We Offer:

  • Highly Competitive Premium Pay: $55.00 - $65.00 per hour—well above regional averages for remote roles.

  • 100% Remote Flexibility: Work from the comfort of your own home office with no commute or travel required.

  • Robust Operational Support: Dedicated administrative teams managing billing, scheduling, and onboarding workflows so you can focus strictly on clinical quality.

  • Consistent Hours: Stable caseloads with reliable weekly billable opportunities.

Requirements:

  • Current and unrestricted certification as a Board Certified Behavior Analyst (BCBA) by the BACB.

  • Active and valid License as a Behavior Analyst (LBA) in the State of New Jersey (Required).

  • Proven experience designing ABA programming and supervising RBTs/behavior technicians (telehealth supervision experience is a plus).

  • Strong tech-literacy and reliable high-speed internet access suitable for secure video conferencing.

  • Excellent communication skills and the ability to collaborate effectively with remote staff and families.

  • Commitment to maintaining the highest professional and ethical standards.