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Remote Physical Therapy Utilization Review Jobs (NOW HIRING)

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

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 ...

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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Remote Physical Therapy Utilization Review information

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How much do remote physical therapy utilization review jobs pay per hour?

As of Jul 26, 2026, the average hourly pay for remote physical therapy 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 in the Remote Physical Therapy Utilization Review position, and why are they important?

To excel as a Remote Physical Therapy Utilization Review professional, you need a background in physical therapy (often with licensure), clinical knowledge, and experience in utilization management or case review. Familiarity with electronic health records (EHR), claims management systems, and industry tools such as InterQual or Milliman criteria is typically required. Strong analytical skills, attention to detail, effective written communication, and the ability to work independently are valuable soft skills for this position. These abilities are crucial for accurately evaluating medical necessity, facilitating reimbursement, and ensuring compliance with healthcare guidelines in a remote setting.

What does a typical day look like for someone in a Remote Physical Therapy Utilization Review role?

A typical day involves reviewing physical therapy documentation and treatment plans submitted by providers to determine if they meet established medical necessity criteria. You may spend most of your workday analyzing patient records, applying evidence-based guidelines, documenting your recommendations, and collaborating virtually with providers, insurance representatives, and your clinical review team. Frequent video meetings and written communications are common as you clarify treatment justifications or support appeals. The role is fast-paced and detail-oriented, requiring strong organizational skills to manage multiple case files and deadlines efficiently. While remote, you remain an integral part of a clinical decision-making team, contributing directly to patient care quality and cost-effective service delivery.

What is a Remote Physical Therapy Utilization Review job?

A Remote Physical Therapy Utilization Review job involves evaluating physical therapy treatment plans and medical records to ensure they meet insurance guidelines and medical necessity. Professionals in this role work remotely to review claims, provide recommendations, and collaborate with healthcare providers and insurance companies. The goal is to ensure appropriate care while preventing unnecessary treatments or costs. This position typically requires a background in physical therapy, strong analytical skills, and knowledge of insurance policies and medical guidelines.

More about Remote Physical Therapy Utilization Review jobs
What cities are hiring for Remote Physical Therapy Utilization Review jobs? Cities with the most Remote Physical Therapy Utilization Review job openings:
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Remote Physical Therapy Utilization Review jobs near you
Infographic showing various Remote Physical Therapy Utilization Review job openings in the United States as of July 2026, with employment types broken down into 94% Full Time, 3% Part Time, and 3% Temporary. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Management Clinical Reviewer (Remote)

Tango Care

Phoenix, AZ • On-site, Remote

Full-time

Posted yesterday

Job description

Description
tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care.
We are currently looking for Clinical Reviewers to join our growing Utilization Management team.
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review activities to ensure the appropriate, efficient, and cost-effective use of home health services. This role evaluates medical necessity for skilled nursing and therapy services (physical therapy, occupational therapy, and speech-language pathology) in accordance with company policies, CMS guidelines (including Medicare Chapter 7), and established clinical criteria such as Milliman Care Guidelines.
The UM Clinical Reviewer collaborates with providers, internal teams, and payer partners to promote high-quality patient outcomes, ensure regulatory compliance, and support optimal care planning across disciplines.
Key Responsibilities:
  • Review and process prior authorization, reauthorization, and continued stay requests for home health services (nursing and therapy)
  • Evaluate medical records and clinical documentation to determine medical necessity and appropriateness of care
  • Apply CMS guidelines, NCQA standards, and internal clinical policies when making authorization determinations
  • Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
  • Collaborate with providers to support appropriate utilization of skilled nursing and therapy visits
  • Serve as a clinical resource to internal team members and external partners, including providers, payers, and case managers
  • Facilitate effective communication to ensure alignment on care plans, documentation standards, and authorization decisions
  • Monitor adherence to home health regulations, documentation standards, and medical necessity criteria
  • Maintain accurate and timely documentation of reviews, decisions, and communications
  • Identify trends or issues impacting quality or utilization and escalate to leadership or quality committees as needed 7
  • Participate in interdisciplinary collaboration and support continuous improvement initiatives
  • Meet productivity, turnaround time, and quality standards for review completion 8
  • Participate in periodic weekend/holiday coverage based on business needs 9 10
  • Perform additional duties as assigned

Office Location:
  • Office located at 2415 E Camelback Road, Suite 700, Phoenix, AZ 85016
  • Remote

Qualifications:
Education & Licensure (one of the following required):
  • Graduate of an accredited nursing program (RN, LPN, or LVN), or
  • Graduate of an accredited Physical Therapy (PT), Occupational Therapy (OT), or Speech-Language Pathology (SLP) program
  • Active, unrestricted clinical license in good standing (multi-state licensure preferred where applicable)

Experience:
  • Minimum 2-5 years of clinical experience (home health, medical/surgical, or therapy setting)
  • Experience in utilization review, case management, or managed care strongly preferred
  • Home health experience strongly preferred

Knowledge and Experience:
  • Strong understanding of home health regulations, CMS guidelines, and medical necessity criteria
  • Knowledge of utilization management principles and care coordination practices
  • Familiarity with NCQA and URAC standards preferred
  • Ability to analyze clinical documentation and make independent, evidence-based decisions
  • Excellent written and verbal communication skills
  • Strong organizational skills with the ability to manage multiple priorities and meet deadlines
  • Ability to work independently while collaborating effectively across teams
  • Customer-service oriented mindset when working with providers and partners
  • Proficiency in Microsoft Office and electronic medical management systems

Additional Expectations
Employees are expected to:
  • Participate in ongoing education and training
  • Stay current on regulatory updates and clinical guidelines
  • Contribute to a culture of quality, compliance, and continuous improvement

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

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