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Remote Insurance Utilization Review Jobs (NOW HIRING)

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

Mountain Region Out of State Staffing

$34.14 - $61.23/hr

... insurance providers to obtain admission and continued stay authorizations as required within the ... Utilization Review experience. * Preferred graduate of an accredited school of nursing (Bachelor ...

Enterprise Engineering

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Concurrent Utilization Review (UR) Nurse

OR · Remote

$30 - $38/hr

Concurrent Utilization Review (UR) Nurse Remote Opportunity Contract to Hire Must be licenses in California The Concurrent Utilization Review (UR) Nurse is responsible for conducting real-time ...

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

As of Aug 2, 2026, the average hourly pay for remote insurance utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.
More about Remote Insurance Utilization Review jobs
What cities are hiring for Remote Insurance Utilization Review jobs? Cities with the most Remote Insurance Utilization Review job openings:
What are the most commonly searched types of Insurance Utilization Review jobs? The most popular types of Insurance Utilization Review jobs are:
What states have the most Remote Insurance Utilization Review jobs? States with the most job openings for Remote Insurance Utilization Review jobs include:
What job categories do people searching Remote Insurance Utilization Review jobs look for? The top searched job categories for Remote Insurance Utilization Review jobs are:
Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in the United States as of July 2026, with employment types broken down into 80% Full Time, and 20% Temporary. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Manager of Utilization Review

ODYSSEY BEHAVIORAL GROUP

Franklin, TN • On-site, Remote

Full-time

Posted 12 days ago

Job description

Position Summary
The Manager of Utilization Review (UR) manages the daily operations of the UR practices for an assigned division. Leads This position ensures timely initial, concurrent, and retrospective reviews are conducted efficiently with a high degree of accuracy. The Manager of Utilization Review collaborates with leaders throughout the company to support denial prevention strategies, regulatory compliance and process optimization. This position serves as an internal subject matter expert and frontline people leader guiding and educating team members on UR functions, tracking and maintaining performance metrics, managing workflows and cross functional collaboration in support of organizational goals.
Relationships and Contacts
Within the organization: Maintains frequent and close working relationships with the Director of Utilization Review, Utilization Review Coordinators, Revenue Cycle team members, Admissions team members, Nursing leadership, milieu leadership, and all clinical team members.
Outside the organization: Initiates and maintains strong professional relationships with clients and families, insurance carrier contacts, referral partners and vendors, as needed.
Position Responsibilities
Essential Responsibilities
  1. Communicates professionally and effectively with multidisciplinary team members, insurance organizations and business offices, providing needed information in a logical, concise manner using technical language that accurately describes clients' condition(s) and treatment needs.
  2. Manages hiring and selection, onboarding training, regular coaching and supervision of Utilization Review Coordinators.
    1. Provides fair and consistent leadership and communication with team members.
    2. Promotes effective team dynamics within and between departments, facilitates team building and professional development for Utilization Review Coordinators.
  3. Assists team members with challenging cases, removing barriers and increasing access to care.
  4. Performs medical records reviews and ongoing training with clinical/medical team members within the assigned division.
  5. Performs regular audits of Utilization Review Coordinator's work to ensure quality and performance.
  6. Maintains current knowledge of Utilization Review process and trends, including denials and concurrent reviews.
  7. Revises processes in collaboration with the Director of Utilization Review to meet organizational goals, as needed.
  8. Utilizes effective documentation standards that support a strong historical record of actions taken on each account.
  9. Maintains a strict level of confidentiality for all client, company, departmental, and healthcare provider information.
  10. Escalates challenges and/or roadblocks to Director of Utilization Review for resolution, as needed.

Additional Responsibilities
  1. Maintains current knowledge of Utilization Review process, including denials and concurrent reviews.
  2. Functions within the guidelines of the corporate Code of Ethics and in accordance with Corporate Compliance standards.
  3. Reads, understands, adheres to, and models all company policy statements on ethics, conduct, and conflict of interests.
  4. Attends and completes all training within assigned time frames.
  5. Performs other duties as assigned.

Education and Experience
Position requires a bachelor's degree or equivalent in combined education and experience, and a minimum of three (3) years' experience with external review organizations or comparable entities doing pre-certification and concurrent reviews in mental health, substance abuse, and/or eating disorder facilities. Requires a comprehensive understanding of the admission, concurrent, continued stay, and retrospective reviews using established facility criteria.
Physical Requirements
  • While performing the duties of this job, the employee will be required to communicate with peers/public, clients and/or vendors.
  • Tolerant to various noise levels: noise level in the work environment varies - may be very quiet to moderate.
  • Job performance will require the ability to sit or remain stationary for extended periods of time.
  • While performing the duties of this job, the employee may be required to talk or hear, sit, and stand.

Additional Requirements
  • Clearance of pre-employment tests, and any other mandatory state/federal requirements.

Skill Competencies
  • Demonstrates a proficient knowledge of medical and behavioral health terminology, and techniques used to diagnose and treat various medical conditions; including practices, standards of care, symptoms, treatment alternatives, medications used for treatment, and preventative healthcare measures.
  • Demonstrated ability to successfully function under pressure in critical situations.
  • Demonstrated ability to effectively manage conflict and crisis situations.
  • Demonstrates strong problem solving and analytical skills.
  • Demonstrates the ability to consistently exercise sound judgment and a high level of discretion.
  • Demonstrates excellent organizational and time management skills.
  • Demonstrates a high level of collaborative skills working with a variety of groups.
  • Demonstrates excellent interpersonal and relationship building skills.
  • Demonstrates a high level of follow-through and attention to detail.
  • Demonstrates excellent verbal and written communication skills.
  • Consistently demonstrates and models alignment with company core values and mission.
  • Demonstrate proficiency with technology resources to include Microsoft Office programs.

Odyssey Behavioral Healthcare, LLC and its subsidiaries provide equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunities apply to all terms and conditions of employment. Odyssey reserves the rights to modify, interpret, or apply this job description in any way the organization desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities. This job description is not an employment contract, implied or otherwise. The employment relationship remains "At-Will."

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