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Remote Utilization Review Manager Jobs (NOW HIRING)

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing ... Proven time management skills with the ability to meet deadlines consistently * Proficiency in ...

Village Care

Utilization Review Nurse

Manhattan, NY · Remote

$95K - $105K/yr

... LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is looking for a self-motivated and ... Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from ...

Medica

Utilization Review III

Minnetonka, MN · Remote

$70.20K - $120.40K/yr

The Utilization Review III position is responsible for the review, investigation, and resolution of ... Proficiency in case management systems and Microsoft Office applications. This position is a Remote ...

Medica

Utilization Review III

Minnetonka, MN · Remote

$70.20K - $120.40K/yr

The Utilization Review III position is responsible for the review, investigation, and resolution of ... Proficiency in case management systems and Microsoft Office applications. This position is a Remote ...

Medica

Utilization Review III

$70.20K - $120.40K/yr

The Utilization Review III position is responsible for the review, investigation, and resolution of ... Proficiency in case management systems and Microsoft Office applications. This position is a Remote ...

CommonSpirit Health

Your ability to manage charts, apply criteria precisely, and communicate effectively with ... THIS IS A REMOTE JOB: Responsibilities: * Conducts admission and continued stay reviews per the ...

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

Responsible for the effective and sufficient support of all Utilization Management activities to ... Remote Contract to Hire VIVA is an equal opportunity employer. All qualified applicants have an ...

The Meadows

Utilization Review Coordinator

Phoenix, AZ · On-site +1

As the Utilization Review Coordinator, you will develop and implement systems for authorizations ... Payer Management * Obtain and maintain authorization for each patient. Problem-solve issues ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105.34K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... POSITION PURPOSE The Utilization Management Nurse evaluates clinical service requests to ensure ...

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Remote Utilization Review Manager information

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$91K

$167.5K

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

As of May 31, 2026, the average yearly pay for remote utilization review manager in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 per year, depending on experience, location, and employer.

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 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 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 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.

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Remote Utilization Review Manager jobs near you

Utilization Review Coordinator (Remote)

Your Behavioral Health

Torrance, CA • Remote

$21 - $26/hr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 6 days ago

Job description

About Us:

Your Behavioral Health is dedicated to providing exceptional, evidence-based mental health and addiction treatment through Clear Behavioral Health and Neuro Wellness Spa. Our UR team plays a vital role in ensuring clients receive timely and medically necessary care.

Position Overview:

We are seeking a detail-oriented, proactive Utilization Review (UR) Coordinator to support insurance authorization processes across all levels of care including Detox, Residential, PHP, IOP as well as Transcranial Magnetic Stimulation (TMS) services. The UR Coordinator will collaborate closely with clinical teams and payors to advocate for clients, secure appropriate insurance authorizations, and support a smooth treatment experience.

Key Responsibilities:

Insurance Authorizations:

  • Obtain initial and concurrent authorizations for Detox, Residential, PHP, and IOP programs
  • Obtain TMS service authorizations for Neuro Wellness Spa
  • Conduct clinical reviews and advocate with commercial health plans to support medically necessary care
  • Track authorization timelines and follow up promptly on outstanding requests

Documentation & Systems:

  • Maintain accurate, real-time records of authorization activity
  • Gather and review clinical documentation to support authorization requests
  • Document all communications with payors clearly and thoroughly

Collaboration & Communication:

  • Communicate regularly with insurance representatives, clinical teams, and leadership about authorization status and updates
  • Work collaboratively with the UR team to improve processes and enhance coordination of care

Denials & Appeals Support:

  • Assist with denial management, support appeal efforts with case summaries and clinical data
  • Help identify trends in authorization delays or denials and provide input to leadership

Other Duties:

  • Perform other responsibilities as assigned to support team goals and company needs

Qualifications:

  • 12 years of utilization review experience, preferably in behavioral health or mental health settings
  • Experience obtaining Detox, Residential, PHP, and IOP authorizations with commercial payors
  • Familiarity with TMS treatment and authorization processes(preferred)
  • Experience with commercial health plans and payor authorization protocols
  • Proficiency with EMR systems, Microsoft Word, and Excel
  • Strong written and verbal communication skills
  • Ability to multitask, prioritize, and work efficiently in a fast-paced environment
  • Professional, collaborative, and passionate about patient advocacy

Schedule:

M-F(hybrid schedule).

Pay:

$21-$26 per hour depending on experience.

Benefits:

  • Medical, dental, and vision insurance
  • Life and disability coverage
  • Retirement plan
  • Paid sick, time off, and holidays
  • Employee Assistance Program
  • Professional development opportunities
  • Other company - sponsored wellness or support programs