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Remote Navihealth Utilization Review Jobs (NOW HIRING)

Gateway Rehab

Utilization Review Liaison - REMOTE

... utilization reviews, and collaborating with clinical teams and insurance providers to support treatment coverage and reimbursement. This position is fully remote and offers the opportunity to make a ...

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... For positions that are available as remote work, Sentara Health employs associates in the following ...

NRG MGMT LLC

Utilization Review Coordinator

Lake Worth, FL · Remote

... utilization review, we help treatment centers optimize revenue cycle management while focusing on ... Remote Position Benefits : • Competitive salary • Health, dental, and vision insurance • ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

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

As of Sep 8, 2026, the average hourly pay for remote navihealth 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 a Remote Navihealth Utilization Review?

A Remote Navihealth Utilization Review position involves evaluating patient medical records and care plans to ensure they meet established guidelines for medical necessity, efficiency, and appropriateness, all while working from a remote location. Professionals in this role typically review clinical information, coordinate with healthcare providers, and make recommendations regarding the most suitable levels of care for patients. They help facilitate transitions of care, reduce unnecessary hospitalizations, and support quality patient outcomes. Navihealth specializes in post-acute care management, so utilization review staff focus on optimizing patient recovery journeys after hospital discharge.

What are the key skills and qualifications needed to thrive as a Remote Navihealth Utilization Review nurse?

To excel as a Remote Navihealth Utilization Review Nurse, you need a current RN license, strong clinical knowledge, and experience in case management or utilization review. Familiarity with Navihealth's Care Management Platform, electronic medical records, and industry-standard utilization review tools is typically required. Strong analytical thinking, attention to detail, and effective written and verbal communication are standout soft skills for this position. These competencies are crucial to ensure accurate care evaluations, efficient care transitions, and compliance with healthcare guidelines in a remote environment.

What are some common challenges faced by Remote Navihealth Utilization Review professionals, and how can they be managed?

Remote Navihealth Utilization Review professionals often encounter challenges such as navigating complex patient cases, maintaining productivity while working independently, and effectively communicating with interdisciplinary teams. Staying organized, utilizing standardized processes, and participating in regular team meetings can help manage these challenges. Leveraging technology and continuously updating clinical knowledge also support effective decision-making and collaboration in a remote environment.

What is the difference between Remote Navihealth Utilization Review vs Remote Case Manager?

AspectRemote Navihealth Utilization ReviewRemote Case Manager
CertificationsRN, LPN, or other healthcare credentials, often with utilization review certificationsRN, LPN, or social work credentials, with case management certifications like CCM
Work EnvironmentRemote, healthcare-focused, primarily reviewing medical necessity and insurance coverageRemote, coordinating patient care, discharge planning, and resource management
Employer & Industry UsageHospitals, insurance companies, healthcare providersHospitals, insurance companies, healthcare organizations

Remote Navihealth Utilization Review specialists focus on assessing medical necessity and insurance coverage, while Remote Case Managers coordinate patient care and discharge planning. Both roles require healthcare credentials and often work remotely within the healthcare industry, but their core responsibilities differ in focus and scope.

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Remote Navihealth Utilization Review jobs near you
Infographic showing various Remote Navihealth Utilization Review job openings in the United States as of September 2026, with employment types broken down into 3% As Needed, 85% Full Time, 3% Part Time, and 9% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Liaison - REMOTE

Remote

Gateway Rehab
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about Gateway Rehabexternal

Full-time

Medical

Posted 6 days ago

Job description

Job Type
Full-time
Description
Gateway Rehab Center (GRC) is hiring a full-time Utilization Review Liaison! In this important administrative and clinical support role, you will help ensure patients receive the appropriate level of care by coordinating authorizations, conducting utilization reviews, and collaborating with clinical teams and insurance providers to support treatment coverage and reimbursement. This position is fully remote and offers the opportunity to make a meaningful impact on patient access to care from your home office. To be considered for the position, you must live within the Pittsburgh, PA area or surrounding counties.
If you're detail-oriented, organized, and enjoy working at the intersection of patient care, insurance, and healthcare operations, keep reading!
Why You'll Love Working at GRC
  • Mission-driven work supporting individuals and families impacted by addiction.
  • Opportunity to play a vital role in ensuring access to treatment services.
  • Collaborative environment working alongside clinical, admissions, and billing teams.
  • Meaningful work that helps patients receive the care they need throughout their recovery journey.
  • Comprehensive benefits package, including contribution toward the medical insurance plan of your choice: Highmark or UPMC, plus access to employee discount programs and additional supportive benefits!

Why This Role is Important to SUD Treatment
GRC's Utilization Review team is changing lives, and as a Utilization Review Liaison, you'll be at the forefront of this effort. By securing and maintaining treatment authorizations, monitoring coverage, and advocating for continued care when needed, you help remove barriers to treatment and ensure patients have access to critical recovery services. Your work directly supports quality patient care, treatment continuity, and organizational success. This is more than an administrative role. It's an opportunity to make a lasting impact on recovery every day.
Responsibilities:
  • Gather clinical information needed for concurrent and retrospective reviews.
  • Complete concurrent and retrospective review processes with payors for treatment authorization.
  • Collaborate with utilization review team members and clinical staff to prepare for reviews and maintain daily workflow.
  • Enter authorization information into the patient database.
  • Communicate authorization status updates to clinical staff.
  • Monitor patients' last covered day of treatment and notify appropriate staff of upcoming coverage expirations.
  • Investigate and resolve issues involving incomplete or missing authorizations.
  • Identify errors that could negatively impact reimbursement for patient treatment.
  • Collaborate with multiple departments to ensure continuity of treatment coverage.
  • Educate clinical and support staff regarding county-funded, managed care, and commercial insurance procedures.
  • Complete peer-to-peer reviews as needed.
  • Communicate discharge information to funding sources when required.
  • Coordinate with clinical teams to ensure funding sources are notified of patient status changes.
  • Investigate denied claims and assist in efforts to recover payment for services rendered.
  • Attend managed care provider meetings as needed.
  • Participate in required GRC trainings and in-service programs.

What You Bring
  • Strong understanding of utilization review, insurance authorization processes, and managed care practices.
  • Excellent verbal and written communication skills.
  • Strong organizational skills and attention to detail.
  • Ability to manage multiple priorities in a fast-paced environment.
  • General understanding of ASAM Criteria.
  • Familiarity with substance use disorder, mental health, and behavioral healthcare treatment services.
  • Strong problem-solving and critical-thinking abilities.
  • Proficiency in Microsoft Office applications, including Word, Excel, and email systems

Requirements
What Do We Require?
  • Bachelor's degree.
  • Familiarity with drug and alcohol treatment, mental health treatment, and/or managed care processes.
  • Proficiency with computer systems and Microsoft Office applications.

Preferred Qualifications
  • Master's degree.
  • Registered Nurse (RN) with current Pennsylvania licensure.
  • Previous experience with utilization review, managed care, insurance authorizations, or healthcare reimbursement processes.

Additional Requirements
  • Pass a PA Criminal Background Check.
  • Obtain PA Child Abuse and FBI Fingerprinting Clearances.
  • Pass a Drug Screen.
  • Complete a 2-Step TB Test.

What Are the Work Conditions?
  • Remote.
  • Prolonged periods of sitting and working on a computer.
  • Minimal physical demands.
  • Significant attention to detail required.
  • Mental demands include problem-solving complex coverage issues, analyzing authorization requirements, and coordinating information across multiple departments.

GRC is an Equal Opportunity Employer committed to diversity, equity, inclusion, and belonging. We value diverse voices and lived experiences that strengthen our mission and impact.

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