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Remote Utilization Review Manager Jobs in Puerto Rico

Deloitte

Epic Denials Management Operator

San Juan, PR · Remote

$17.75 - $23.50/hr

This is a primarily remote role supporting enterprise Epic support, with minimal travel and ... Review hospital account records and payer remittance records, communicate with relevant Client RCM ...

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Remote Utilization Review Manager information

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?

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 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 are popular job titles related to Remote Utilization Review Manager jobs in Puerto Rico?

For Remote Utilization Review Manager jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in Puerto Rico look for?

The top searched job categories for Remote Utilization Review Manager jobs in Puerto Rico are:

Remote Utilization Review Manager jobs near you

Flexible remote AI work. Your schedule. Paid weekly, straight to your bank account.

Meridian.ai

Aguadilla, PR • Remote

Full-time

Posted 2 days ago

New

Job description

What You'll Do

Review and label digital content including text, images, and documents. Every task you complete helps improve how technology interprets information and performs in practical settings.

Who We're Looking For

Detail-oriented individuals who take quality seriously and can follow detailed instructions consistently. Strong readers and writers with good judgment are a great fit. Prior experience in data labeling, annotation, research, writing, or operations is helpful but not required.

Requirements
  • Strong attention to detail
  • Clear written communication skills
  • Reliable internet connection and computer
  • Ability to work independently and meet deadlines
  • Basic familiarity with web-based tools or online forms
What We Offer
  • Remote, flexible contract work
  • Clear guidelines and training
  • Performance feedback and opportunities to grow
  • A mission-driven team focused on accuracy and quality

Ready to apply? Join a team helping build the data foundation behind better technology.

Workada is an Equal Opportunity Employer.

Apply