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Remote Utilization Management Jobs in Miami, FL (NOW HIRING)

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Miami, FL

Remote Utilization Management information

See Miami, FL salary details

$20

$40

$65

How much do remote utilization management jobs pay per hour?

As of Aug 2, 2026, the average hourly pay for remote utilization management in Miami, FL is $40.44, according to ZipRecruiter salary data. Most workers in this role earn between $31.97 and $46.44 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 as a Remote Utilization Management Nurse, and why are they important?

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 Miami, FL? The most popular types of Utilization Management jobs in Miami, FL are:
What are popular job titles related to Remote Utilization Management jobs in Miami, FL? For Remote Utilization Management jobs in Miami, FL, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Miami, FL look for? The top searched job categories for Remote Utilization Management jobs in Miami, FL are:
What cities near Miami, FL are hiring for Remote Utilization Management jobs? Cities near Miami, FL with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Miami, FL as of July 2026, with employment types broken down into 6% As Needed, 72% Full Time, 11% Part Time, and 11% Contract. Highlights an 72% In-person, and 28% Remote job distribution, with an average salary of $84,116 per year, or $40.4 per hour.

Remote Utilization Review RN (Hospital-Based Experience Required)

HealthPlus Staffing

Fort Lauderdale, FL • Remote

$80K - $105K/yr

Full-time

Posted yesterday

New

Job description

Quick Job Details:

Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard Business Hours

Job Requirements:
  • Active RN license with Multi-State/Compact License required
  • Minimum 2 years of Utilization Review experience within a hospital or health system (provider-side required)
  • Payer/insurance-only Utilization Management experience is not eligible
  • Minimum 3 years of acute care/hospital RN experience
  • Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
  • Experience applying InterQual and/or MCG criteria preferred
  • Excellent communication, analytical, and critical thinking skills
  • Ability to work independently in a remote environment
Responsibilities:
  • Conduct admission, concurrent/continued stay, and observation reviews
  • Apply medical necessity criteria to determine appropriate level of care
  • Escalate cases to Physician Advisors when appropriate
  • Collaborate with physicians, case managers, and insurance payers
  • Support denial prevention, documentation improvement, and revenue cycle initiatives
  • Ensure compliance with payer guidelines, CMS, and regulatory requirements
  • Analyze clinical and financial data to identify quality improvement opportunities

Compensation: Competitive; based on experience

Benefits: Comprehensive benefits package

About Us

HealthPlus Staffing is a national leader in healthcare staffing. We partner with leading healthcare organizations nationwide to connect highly qualified professionals with exceptional career opportunities.

Our Promise
  • Direct access to hiring decision-makers
  • Timely feedback throughout the interview process
  • Dedicated support to help you make an informed career decision

If you're interested in this opportunity, please submit your application or call 561-291-7787 to speak with one of our experienced recruiters. We look forward to helping you find your next opportunity!

The HealthPlus Team