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Remote Utilization Review Manager Jobs in Florida

Guardian Recovery

UR COORDINATOR

Delray Beach, FL · On-site +1

$60K - $75K/yr

The Utilization Review Coordinator (UR Coordinator) is responsible to perform the process of utilization review to ensure appropriate reimbursement by third party payers. This includes managing ...

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Remote Utilization Review Manager information

What are some common challenges faced by a Remote Utilization Review Manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What is a Remote Utilization Review Manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review Manager, and why are they important?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.
What are the most commonly searched types of Remote Utilization Review jobs in Florida? The most popular types of Remote Utilization Review jobs in Florida are:
What are popular job titles related to Remote Utilization Review Manager jobs in Florida? For Remote Utilization Review Manager jobs in Florida, the most frequently searched job titles are:
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What cities in Florida are hiring for Remote Utilization Review Manager jobs? Cities in Florida with the most Remote Utilization Review Manager job openings:
Remote Utilization Review Manager jobs near you

Utilization Review Coordinator | Remote

Atlantic Health Strategies

Boca Raton, FL • On-site, Remote

$50K - $80K/yr

Full-time

Posted 7 days ago

Job description


About the Organization
Lotus Healthcare Billing is a behavioral health billing operation based in Boca Raton, Florida, supporting treatment programs through insurance authorization, utilization review, and payer communication. The team works closely with clinical staff to ensure that patients can access the levels of care they need, from detox through outpatient services.
The Opportunity
We are seeking a detail-oriented Utilization Review Coordinator to join the Lotus Healthcare Billing team. This full-time, remote role is well suited to someone who is organized, communicates clearly, and is comfortable managing a caseload where timelines directly affect patient care. A hybrid schedule with time in the Boca Raton office may be available for the right candidate. No prior utilization review experience is required. Training will be provided for the right candidate.
What You'll Do
  • Conduct daily phone contact with insurance companies to secure authorizations for behavioral health and substance use disorder treatment.
  • Manage a caseload of active authorizations, tracking timelines closely since they directly affect patient care.
  • Apply knowledge of SUD and behavioral health levels of care, including detox, residential, PHP, IOP, and outpatient, when communicating with payers.
  • Reference ASAM criteria and medical necessity standards to support authorization requests.
  • Use systems such as KIPU, Availity, or other payer portals to document and track review activity.
  • Communicate professionally and consistently with insurance representatives and internal clinical teams.
  • Work independently while staying aligned with program and compliance expectations.

Requirements
Requirements
  • High school diploma or equivalent required; associate's or bachelor's degree a plus.
  • Less than one year of relevant experience required; training provided for the right candidate.
  • Experience in utilization review, insurance authorization, or behavioral health billing preferred.
  • Familiarity with SUD/behavioral health levels of care (detox, residential, PHP, IOP, OP) is a strong plus.
  • Knowledge of ASAM criteria and medical necessity standards a plus.
  • Experience with KIPU, Availity, or payer portals preferred.
  • Strong organizational skills and attention to detail.
  • Clear, professional communication skills.
  • Comfortable working independently and managing a caseload.
  • Reliable home internet and a private, HIPAA-compliant workspace for remote work.

Benefits
Compensation and Schedule
  • Salary: $50,000 to $80,000 annually, commensurate with experience.
  • Schedule: Days, full-time, remote (hybrid option available for the right candidate).

This opportunity is posted by Atlantic Health Strategies on behalf of Lotus Healthcare Billing in Boca Raton, Florida.

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