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Remote Insurance Utilization Review Jobs in Rochester, NY

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Remote Insurance Utilization Review information

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

As of Sep 10, 2026, the average hourly pay for remote insurance utilization review in Rochester, NY is $41.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 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 Rochester, NY?

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

What cities near Rochester, NY are hiring for Remote Insurance Utilization Review jobs?

Cities near Rochester, NY with the most Remote Insurance Utilization Review job openings:

Infographic showing various Remote Insurance Utilization Review job openings in Rochester, NY as of August 2026, with employment types broken down into 93% Full Time, and 7% Contract. Highlights an 100% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.

Remote Clinical Social Worker - Hospice Focus

York, NY • Remote

Full-time

Medical, Dental, Vision, Life

Posted 23 days ago


Job description

Position Overview

Gotham Enterprises Ltd is seeking a dedicated Licensed Clinical Social Worker (LCSW) for a full-time remote position, primarily serving patients within our Hospice Center. In this vital role, you will utilize your clinical expertise and compassionate approach to provide essential support to individuals facing significant health challenges and their families, ensuring they receive the highest quality of care from the comfort of your home.

About the Organization

Gotham Enterprises Ltd is a leading provider of mental health services, committed to enhancing the quality of life for our clients. Our Hospice Center specializes in compassionate end-of-life care, where we integrate mental health support with medical care. By focusing on holistic well-being, we strive to alleviate suffering and enhance the dignity of our patients during their final stages of life.

Work Environment

This role is fully remote, offering a flexible work environment that allows our social workers to thrive without the distractions of a traditional office. You will interact with colleagues and clients through secure telehealth platforms, fostering productive communication while maintaining a healthy work-life balance. By eliminating the need for a daily commute, we enable you to dedicate more time to patient care, consultations, and personal well-being.

Key Responsibilities
  • Conduct thorough clinical assessments of patients, developing individualized treatment plans that align with best practices in hospice care, focusing on emotional and psychological support.
  • Implement various therapeutic interventions, such as cognitive-behavioral therapy (CBT) and solution-focused therapy, which are tailored to meet the unique needs of terminally ill clients and are adapted for the virtual environment.
  • Maintain comprehensive clinical documentation ensuring compliance with state and federal regulations using secure electronic health record (EHR) systems.
  • Collaborate with an interdisciplinary team of healthcare professionals, such as nurses, physicians, and palliative care specialists, through virtual meetings to ensure cohesive care delivery.
  • Participate in case consultations and peer review sessions utilizing advanced video conferencing tools to discuss patient progress and share strategies that enhance care quality.
  • Educate patients and families on mental health resources and coping strategies related to end-of-life issues, ensuring they feel supported and informed throughout the care process.
  • Stay informed on current trends and advances in hospice and mental health care through continuous professional development activities, such as webinars and online educational resources.
Patient Population / Client Focus

In this role, you will support a diverse population of patients, primarily those receiving hospice care, along with their families. You will navigate complex emotional landscapes, helping individuals cope with grief, anxiety, and the myriad challenges associated with end-of-life issues. Your ability to provide empathetic and solution-focused therapy will be vital in improving their mental health and overall quality of life.

Qualifications
  • A Master's degree in Social Work from an accredited institution.
  • A valid state license to practice as a Licensed Clinical Social Worker (LCSW).
  • Minimum of 2 years of clinical experience specializing in mental health, with an emphasis on providing services in hospice or palliative care settings.
  • Demonstrated expertise in evidence-based therapeutic interventions capable of being delivered effectively in a remote environment.
  • Exceptional communication and interpersonal skills, adept at establishing rapport with patients and their families through virtual platforms.
  • Strong analytical and problem-solving skills, demonstrating the ability to address the unique challenges of remote services.
  • A commitment to working both independently and collaboratively as part of a virtual care team.
Preferred Experience
  • Prior experience in end-of-life care or hospice settings is highly beneficial.
  • Familiarity with telehealth services and electronic health record management.
Compensation and Benefits
  • We offer a competitive annual salary in the range of USD 80,000 – 104,000 based on experience and qualifications.
  • Comprehensive medical, dental, and vision insurance to support your personal health needs.
  • Life and disability insurance for added peace of mind.
  • Access to malpractice insurance to facilitate your practice confidently and securely.
  • Participation in our employee assistance program offering additional mental health resources and counseling.
  • Unlimited patient referrals to support a steady caseload, allowing you to focus on quality care instead of administrative burdens.
  • Streamlined administrative processes to reduce paperwork and enhance the efficiency of patient care.
Career Growth Opportunities

At Gotham Enterprises Ltd, we believe in investing in our team members' professional development. You will have access to ongoing training and advancement opportunities within the organization, enabling you to grow your skill set and progress through various roles within our network of mental health services.

Why Join Our Team

Gotham Enterprises Ltd is not just a workplace—it's a commitment to compassionate care. Joining our team means becoming a part of a supportive community that values each member's contributions and fosters a culture of respect and innovation. If you are passionate about making a positive difference in people’s lives and seek a fulfilling remote work experience, we would love to welcome you aboard.

Application Information

If you are ready to embark on a meaningful career that directly impacts the lives of patients and families, we encourage you to apply today. Please submit your resume and a cover letter outlining your relevant experience and why you are the ideal fit for this role. Join us at Gotham Enterprises Ltd and help us shape the future of mental health care!