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Remote Utilization Management Jobs in Scranton, PA

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Remote Utilization Management information

See Scranton, PA salary details

$21

$41

$68

How much do remote utilization management jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for remote utilization management in Scranton, PA is $41.85, according to ZipRecruiter salary data. Most workers in this role earn between $33.08 and $48.08 per hour, depending on experience, location, and employer.

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 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.

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 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 popular job titles related to Remote Utilization Management jobs in Scranton, PA?

For Remote Utilization Management jobs in Scranton, PA, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management jobs in Scranton, PA look for?

The top searched job categories for Remote Utilization Management jobs in Scranton, PA are:

What cities near Scranton, PA are hiring for Remote Utilization Management jobs?

Cities near Scranton, PA with the most Remote Utilization Management job openings:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Scranton, PA as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 19% Part Time, and 3% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $87,057 per year, or $41.9 per hour.

Physician Peer Reviewer- Dermatologist

Federal Hearings And Appeals

Wilkes Barre, PA • Remote

Contractor

Re-posted 17 days ago

Job description

Physician Peer Reviewer –

Federal Hearings and Appeals Services (FHAS) is a URAC-accredited Independent Medical Review Organization (IRO) with Health Utilization Management (HUM) accreditation. For the past 30 years, FHAS has provided external peer review services to healthcare organizations, government agencies, insurance companies, and legal entities.

FHAS is currently expanding its elite panel of physicians licensed to assist with independent review claims and appeals in any of the following specialties:

Addiction Medicine, Allergy & Immunology, Anesthesiology, Cardiovascular Disease, Child & Adolescent Psychiatry, Chiropractic Medicine, Dentist, Dermatology, Emergency Medicine, Endocrinology, Diabetes, & Metabolism, Family Medicine, Gastroenterology, Internal Medicine, Interventional Cardiology, Interventional Radiology & Diagnostic Radiology, Medical Genetics & Genomics, Medical Oncology, Nephrology, Neurological Surgery, Neurology, Obstetrics and Gynecology, Ophthalmology, Orthopedic Surgery, Pain Medicine, Pathology, Pediatrics, Pediatric Cardiology, Pediatric Critical Care Medicine, Developmental-Behavioral Pediatrics, Pediatric Emergency Medicine, Pediatric Gastroenterology, Pediatric Nephrology, Physical Medicine & Rehabilitation, Plastic Surgery, Psychiatry, Psychology *PhD, Radiation Oncology, Radiology, Rheumatology, Sleep Medicine, Thoracic & Cardiac Surgery, Transplant Hepatology, Undersea & Hyperbaric Medicine

Description

  • Responsible for reviewing medical case files and making medical determinations. Cases may include medical necessity and medical appropriateness, experimental or investigational treatment, administrative or legal issues, or a combination of these categories, which are filed with the Department of Human Services’ Bureau of Hearings and Appeals (BHA).
  • Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
  • Completes and evaluates the review process in a regulatory timeframe.

Work Experience Requirements

  • Successful completion of a Residency or Fellowship Program
  • Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review.
  • License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer.
  • License is of the type and scope that permits applying clinical judgement in consideration of an individual members clinical needs to render a decision.
  • For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.
  • Must hold a current board certification issued by the American Board of Medical Specialties or American Osteopathic Association.
  • 5-years or more post graduate active clinical experience in direct patient care
  • Experience providing direct patient care within the past 3 years, if performing external reviews

Job Type

Contract

Work Location

Remote