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Remote Utilization Review Manager Jobs in Boca Raton, FL

NRG MGMT LLC

Collections Specialist

Lake Worth, FL · On-site +1

$16.50 - $22.25/hr

... cycle management company specializing in medical billing, collections, utilization review, and ... Work Environment Office or remote work environment, depending on company policy. Fast-paced ...

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Boca Raton, FL

Remote Utilization Review Manager information

See Boca Raton, FL salary details

$37K

$86.4K

$159K

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 Boca Raton, FL is $86,367.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,500.00 and $103,900.00 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 Boca Raton, FL?

The most popular types of Remote Utilization Review jobs in Boca Raton, FL are:

What are popular job titles related to Remote Utilization Review Manager jobs in Boca Raton, FL?

For Remote Utilization Review Manager jobs in Boca Raton, FL, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in Boca Raton, FL look for?

The top searched job categories for Remote Utilization Review Manager jobs in Boca Raton, FL are:

What cities near Boca Raton, FL are hiring for Remote Utilization Review Manager jobs?

Cities near Boca Raton, FL with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you

Licensed Physician Reviewer

Miami, FL • On-site, Remote

ChenMed, LLC
Health Care and Social Assistance • 5 - 10K employees
Learn more about ChenMed, LLCexternal

$204K - $292K/yr

Full-time

Re-posted yesterday

ChenMed rating

8.4

Company rating: 8.4 out of 10

Based on 40 frontline employees who took The Breakroom Quiz

Job description

We're unique. You should be, too.
We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?
We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.
The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management.ESSENTIAL JOB DUTIES/RESPONSIBILITIES:
  • Provides Delegated UM by covering the specified territories as assigned:
    • Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on all health plan and local calls; calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories.
  • Advises other physician reviewers.
  • Other duties as assigned and modified by manager.
KNOWLEDGE, SKILLS AND ABILITIES:
  • Excellent analytical and deductive reasoning skills
  • Good judgement and problem-solving skills
  • Professional and effective communication skills
  • Strong organizational skills
  • Written and verbal fluency in English
  • Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint

EDUCATION AND EXPERIENCE CRITERIA:
  • Graduate from accredited Medical School with a valid, unrestricted license is required
  • Completion of Internal Medicine or Family Practice residency
  • Board Certification in Infectious Disease
  • Two (2) years' experience in Hospital medicine preferred
  • At least one (1) year of utilization review experience preferred

PAY RANGE:
$204,761 - $292,515 Salary
The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.
EMPLOYEE BENEFITS
https://chenmed.makeityoursource.com/helpful-documents
We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care.
ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day.
Current employees, if you want to apply to our internal career site, please click HERE
Current Contingent Worker please see job aid HERE to apply
#LI-Remote

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About ChenMed

Sourced by ZipRecruiter

We're expanding healthcare equity across America. We're already in 15 states with 100+ medical centers. As a rapidly growing, physician-led organization, we have one central focus: rescue any and every senior from a healthcare system that has failed them. Our family of brands include Chen Senior Medical Center, JenCare Senior Medical Center, and Dedicated Senior Medical Center. Recently named a 2021 Best Places To Work and one of the only healthcare companies recognized in Fortune's 2020 "Change The World" list, ChenMed prides itself on creating a culture that enables career growth and promotes inclusion for all.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Miami, FL, US

Year founded

1985

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