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Remote Utilization Review Manager information

See Baton Rouge, LA salary details

$37.4K

$87.4K

$160.8K

How much do remote utilization review manager jobs pay per year?

As of Sep 10, 2026, the average yearly pay for remote utilization review manager in Baton Rouge, LA is $87,392.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,100.00 and $105,100.00 per year, depending on experience, location, and employer.

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 the most commonly searched types of Remote Utilization Review jobs in Baton Rouge, LA?

The most popular types of Remote Utilization Review jobs in Baton Rouge, LA are:

What are popular job titles related to Remote Utilization Review Manager jobs in Baton Rouge, LA?

For Remote Utilization Review Manager jobs in Baton Rouge, LA, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in Baton Rouge, LA look for?

The top searched job categories for Remote Utilization Review Manager jobs in Baton Rouge, LA are:

What cities near Baton Rouge, LA are hiring for Remote Utilization Review Manager jobs?

Cities near Baton Rouge, LA with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you

Compliance Manager

Baton Rouge, LA • On-site, Remote

Magellan Health Services
Biotechnology Research and Development • 10K+ employees
Learn more about Magellan Health Servicesexternal

$77K - $124K/yr

Full-time

Medical, Life

Re-posted 18 days ago

Job description

This position is available for remote/WFH within Louisiana, candidates must reside in Louisiana.

Serves as the compliance and privacy manager for assigned areas of the company or an SBU as applicable. Assists with regulatory and contract compliance for business managed by the Care Center or supported by corporate compliance. Responsible for the implementation of or support of the SBU and/or Corporate Compliance Program, Health Insurance Portability and Accountability Act (HIPAA) compliance, including audits and the preparation for state and customer audits.
  • If applicable, oversees the implementation and ongoing operation of the Compliance Program for the assigned SBU(s).
  • If applicable, develops and annually updates a formal written compliance program for the assigned Care Management Center and educates staff about compliance and the appropriate details of the compliance program.
  • Directs federal and state regulatory and compliance activities.
  • Customizes corporate policies where necessary to address state regulatory standards and/or contractual requirements and, where applicable and works with corporate compliance on any customizations that are required due to state regulatory standards.
  • Serves as a liaison for customers on legal and regulatory issues.
  • If applicable, chairs the local compliance committee meetings.
  • Coordinates activities with the Internal Audit and Special Investigations Unit (SIU) on compliance matters including fraud, waste, and abuse auditing and monitoring, as directed.
  • Ensures corrective actions are implemented for all known compliance deficiencies. Submits reports to the Quality Improvement Committee (QIC), Compliance Committee, Business Unit Manager, and the corporate Compliance Department as appropriate.
  • Maintains expertise related to authorization and non-authorization correspondence requirements from the perspective of the Employee Retirement Income Security Act of 1974 (ERISA), National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), federal regulations and state law.
  • Assists in review of standard correspondence, notifying policy content experts of changes to standard policies, and working with IT regarding system changes as it relates to correspondence.
  • If applicable, attends customer meetings to report on compliance matters.
  • Serves as central contact for internal and external customers regarding certain parts of the corporate compliance program as assigned or, where applicable, security, HIPAA, and anti-fraud efforts within the assigned Care Center.
  • Assists with internal and external audits and reporting, including periodic reports documenting compliance status..
  • If applicable, oversees Care Center-delegated entities and their compliance activities and assure that compliance data from the delegated entities are reported to the Quality Improvement Committee (QIC).
The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Other Job Requirements

Responsibilities

Knowledge of HIPAA, federal and state regulatory processes.
Medicare Advantage and/or Medicaid managed care experience preferred but not required.
Strong interpersonal, organizational, and project management skills.
Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
Excellent verbal and written communication skills.
5-8 years compliance related experience.
Experience and thorough understanding of Microsoft Office, flow charting and other relevant software systems and applications.

General Job Information

Title

Compliance Manager - Louisiana

Grade

27

Work Experience - Required

Compliance

Work Experience - Preferred

Healthcare

Education - Required

A Combination of Education and Work Experience May Be Considered., Bachelor's

Education - Preferred

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:

$77,785

Salary Maximum:

$124,455

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

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