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Remote Insurance Utilization Review Jobs (NOW HIRING)

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

... of insurance industry, medical coding (CPT/HCPCS/ICD-10), and overall claims process a plus ... Remote Contract to Hire VIVA is an equal opportunity employer. All qualified applicants have an ...

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

Remote : Mondays and Fridays * On-site in our Denver Office: Tuesdays, Wednesdays, and Thursdays The compensation range for this position is based upon candidate experience and market expectations.

New

Medica

Utilization Review III

Minnetonka, MN · Remote

$70.20K - $120.40K/yr

The Utilization Review III position is responsible for the review, investigation, and resolution of ... This position is a Remote role.To be eligible for consideration, candidates must have a primary ...

Medica

Utilization Review III

Minnetonka, MN · Remote

$70.20K - $120.40K/yr

The Utilization Review III position is responsible for the review, investigation, and resolution of ... This position is a Remote role.To be eligible for consideration, candidates must have a primary ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105.34K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105.34K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Medica

Utilization Review III

$70.20K - $120.40K/yr

The Utilization Review III position is responsible for the review, investigation, and resolution of ... This position is a Remote role. To be eligible for consideration, candidates must have a primary ...

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 ...

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

As of May 31, 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 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.

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 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.

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What cities are hiring for Remote Insurance Utilization Review jobs? Cities with the most Remote Insurance Utilization Review job openings:
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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
Utilization Review Nurse

Utilization Review Nurse

VIVA USA INC

Nashville, TN • On-site, Remote

$37.22 - $42.22/hr

Contractor

Posted 27 days ago

Job description

Job Description
Registered Nurse responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: drugs and biologics, inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts.
Essential Duties and Responsibilities:
Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines.
Uses an established set of criteria to evaluates and authorize the medical necessity of services.
Provide notification of decisions in accordance with compliance guidelines.
Coordinate with Medical Directors when services do not meet criteria or require additional review.
Participation in staff meetings, regular trainings and other collaborative meetings as appropriate.
Works with management team to achieve operational objectives and financial goals.
Supports teams across UM Department as needed.
Active participation and completion of all required trainings.
Maintain Required Licensures.
Adherence to regulatory and departmental timeframes for review of requests
Meet/exceed department Turn Around time, daily established productivity goals, and service levels
Proficient knowledge of policies and procedures, Medicare, HIPPA and NCQA standards;
Professional demeanor and the ability to work effectively within a team or independently;
Flexible with the ability to shift priorities when required
Other duties as required
Qualifications:
Current unrestricted RN license. Multi-State License Preferred
Bachelor's degree in nursing or health-care related field preferred
Minimum of 2 years' experience in a regulated environment preferred
Minimum of 2-3 years clinical experience
Strong customer orientation
Strong organizational, planning, and communication skills
Working knowledge of insurance industry, medical coding (CPT/HCPCS/ICD-10), and overall claims process a plus
Knowledge of National Coverage Determinations, Local Coverage Determinations and MCG criteria are a plus.
Excellent time management skills
Knowledge, Skills, Abilities Required:
Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
Able to work in a dynamic, fast-paced team environment and to promote team concepts
Excellent typing skills.
Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word.
Required Qualifications:
RN
Notes:
Remote
Contract to Hire
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

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