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Remote Utilization Management Jobs in Pennsylvania

Geisinger Health

Medical Director Medicaid

Danville, PA · On-site +1

Partner with Quality, Utilization Management, Case/Disease Management, Pharmacy, Behavioral Health ... Pennsylvania (onsite/hybrid/remote with periodic in-state travel) Education: Doctor of Medicine or ...

Highmark Health

Intake Coordinator

Pittsburgh, PA · Remote

$17.50 - $23.75/hr

Highmark Inc. : JOB SUMMARY This job captures all inbound inquires for utilization management ... Remote-based Teaches / trains others Occasionally Travel from the office to various work sites or ...

Bcbsa

Director, Trade Client Relations

Indiana, PA · Remote

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

New

Bcbsa

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Pennsylvania

Remote Utilization Management information

See Pennsylvania salary details

$21

$42

$69

How much do remote utilization management jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for remote utilization management in Pennsylvania is $42.38, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $48.65 per hour, depending on experience, location, and employer.

How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive in remote utilization management?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Pennsylvania? The most popular types of Utilization Management jobs in Pennsylvania are:
What are popular job titles related to Remote Utilization Management jobs in Pennsylvania? For Remote Utilization Management jobs in Pennsylvania, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Pennsylvania look for? The top searched job categories for Remote Utilization Management jobs in Pennsylvania are:
What cities in Pennsylvania are hiring for Remote Utilization Management jobs? Cities in Pennsylvania with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Pennsylvania as of August 2026, with employment types broken down into 96% Full Time, and 4% Contract. Highlights an 100% Remote job distribution, with an average salary of $88,158 per year, or $42.4 per hour.

Medical Director, Utilization Management

UPMC Health Plan

Pittsburgh, PA • Remote

Other

Re-posted 4 days ago

Job description

Purpose:
The UPMC Health Plan is seeking a Medical Director to join our Utilization Management team. The ideal candidate will have a minimum of 10 years of clinical experience, as well as experience working with a Health Plan.

The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health Plan members. This fully remote role will be responsible for assuring physician commitment and delivery of comprehensive high quality health care to UPMC Health Plan members. Oversees adherence to quality and utilization standards through committee delegations, and further establishes an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers.

UPMC offers a premier benefits package, designed to care for your total well-being - physically, emotionally, and financially - paired with endless opportunities for career advancement and growth. Discover the culture, the teams, and the passions that drive us to make Life Changing Medicine happen.
Responsibilities:

  • Provide leadership direction for provider credentialing processes.
  • Physicians must devote sufficient time to the CHC-MCO to provide timely medical decisions, including after-hours consultation, as needed
  • Provide leadership and direction in meeting Quality Improvement and Care Management goals directed at improvements in member health status outcomes and established business strategies.
  • Provide expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan.
  • Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and retrospective reviews, member grievances, provider appeals, and potential quality of care concerns.
  • Keep current with accepted standards and professional developments in the areas of quality improvement and utilization management.
  • Communicate and educate network providers regarding clinical guidelines, pathways, protocols, and standards related to quality and utilization processes.
  • Responsible for reporting the communication of reportable communicable diseases in accordance with statute.
  • Interacts with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and Quality Improvement policies and procedures.
  • Work with the DOH State and District Office Epidemiologists in partnership with the designated county/municipal health department staff to appropriately report reportable conditions in accordance with 28 Pa. Code 27.1 et seq.
  • Daily interventions support implementation of the Health Plan's Quality Improvement and Care Management Programs.
  • Represent the Health Plan in external accreditation and certification activities.
  • Act as first level physician reviewer for all cases referred by the Quality Improvement and Care Management Departments.
  • Daily activities support adherence to quality and utilization standards, and establish an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers.
  • Doctor of Medicine or Doctor of Osteopathy from an accredited school Required
  • The ideal candidates will have a minimum of 5-10 years of clinical experience
  • Managed Care experience preferred
  • Preference will be given to candidates with board certification in Internal Medicine, Family Medicine, Geriatric Medicine or Emergency Medicine
    Licensure, Certifications, and Clearances:
  • Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)
  • PA Medical License


UPMC is an Equal Opportunity Employer/Disability/Veteran

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