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Remote Utilization Review Rn Jobs in Boca Raton, FL

Aspirion

Clinical Nurse Specialist

Delray Beach, FL · Remote

... RN license (required) What we would like to see * 1+ year experience in utilization review, case ... US remote-based colleagues are not permitted to work from a location outside of the United States ...

Aspirion

Clinical Nurse Specialist

Delray Beach, FL · Remote

$68K - $100K/yr

... RN license (required) What we would like to see * 1+ year experience in utilization review, case ... US remote-based colleagues are not permitted to work from a location outside of the United States ...

ChenMed

Licensed Physician Reviewer-GI (remote)

Miami, FL · Remote

$204K - $292K/yr

... Nursing Facility (SNF) meetings covering the assigned territories. * Advises other physician ... At least one (1) year of utilization review experience preferred PAY RANGE: $204,761 - $292,515 ...

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Remote Utilization Review Rn information

See Boca Raton, FL salary details

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How much do remote utilization review rn jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for remote utilization review rn in Boca Raton, FL is $40.12, according to ZipRecruiter salary data. Most workers in this role earn between $31.73 and $46.06 per hour, depending on experience, location, and employer.

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

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

What is the difference between Remote Utilization Review Rn vs Remote Case Manager Rn?

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.
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Remote Utilization Review Rn jobs near you

Utilization Review Specialist

Cutting Edge Staffing LLC

Pompano Beach, FL • Remote

Full-time

Posted 3 days ago

Job description

Exciting Opportunity with Banyan Treatment Centers!

We are seeking a Utilization Review Specialist to join our corporate team in Pompano Beach, FL. The position is responsible for contacting external case managers and managed care organizations for pre-authorization and concurrent reviews for the duration of a patient’s treatment stay. They also establish and maintain contracts with managed care companies and requests rate increases when deemed appropriate.

Position Details:
  • Reports To: Director of Utilization Review
  • Schedule: Full-Time, Weekdays (Weekend availability as needed).
  • Location: Remote
Key Responsibilities:

  • Manage a caseload of 50–75 patients and authorize 15–25 cases daily, ensuring timely utilization reviews and appropriate level of care.

  • Verify insurance benefits, coordinate authorizations, and communicate effectively with managed care providers.

  • Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards.

  • Collaborate with clinical and billing departments to support discharge planning, documentation, and timely reimbursement.

  • Identify and address over/underutilization trends and assist in resolving outstanding case issues with insurers.

Requirements:
  • High School diploma or equivalent; graduate degree in a health or behavioral health related field preferred.
  • Minimum of one-year experience working in a utilization review position (psychiatric or chemical dependency).
    Why Join Banyan Treatment Centers?

    This is more than a job, it’s a chance to be a vital part of what recovery looks like after treatment. As a Utilization Review Specialist, you’ll help ensure that each client leaves treatment with a clear plan, strong connections, and the resources they need to continue their recovery journey with confidence.

    • Join a Mission-Driven, Nationally Recognized Organization: We’re accredited by the Joint Commission and backed by TPG’s Rise Fund, with 18 locations and Telehealth services nationwide.
    • Champion the Continuum of Care: Be a key player in ensuring clients transition successfully from treatment into long-term recovery supports.
    • Work in Partnership: Collaborate with clinical, operational, and business development teams, as well as families and external partners, to make sure no detail is missed.
    • Enjoy Comprehensive Benefits: Including medical, vision, and dental insurance; whole and term life insurance; short- and long-term disability coverage; 401(k) with employer match; paid time off and holidays; and wellness, assistance, and referral programs.
    Apply Now!

    If you're passionate about building bridges to lasting recovery and ensuring every patient has a plan beyond our doors, apply today and help us continue making a difference at Banyan Treatment Centers.

    We are an Equal Opportunity Employer and welcome applicants of all backgrounds. We encourage veterans, active-duty military, and first responders to apply in support of our First Responders Program.