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Remote Utilization Review Jobs in Florida (NOW HIRING)

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

Experience with DME, utilization review, EMRs, care management platforms, and Microsoft Office ... This is a fully remote position with typical business hours; however, there may be instances when ...

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

Experience with DME, utilization review, EMRs, care management platforms, and Microsoft Office ... This is a fully remote position with typical business hours; however, there may be instances when ...

MRIoA

Child & Adolescent Psychiatrist

Orlando, FL · On-site +1

We are currently seeking Board-Certified physicians in Child & Adolescent Psychiatry to conduct independent Utilization Reviews . This is a flexible, fully remote opportunity requiring just 1-2 hours ...

NRG MGMT LLC

Collections Specialist

Boca Raton, FL · On-site +1

$17.50 - $23.75/hr

... utilization review, and insurance verification for substance abuse and mental health treatment ... Work Environment Office or remote work environment, depending on company policy. Fast-paced ...

Oscar Health

Sr. Quality of Care Review Nurse

Miami, FL · Remote

$83K - $109K/yr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas ... Health plan utilization management experience or case management experience. * Experience in health ...

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Remote Utilization Review information

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$15

$31

$51

How much do remote utilization review jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for remote utilization review in Florida is $31.60, according to ZipRecruiter salary data. Most workers in this role earn between $24.95 and $36.30 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What is a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What are the most commonly searched types of Utilization Review jobs in Florida?

The most popular types of Utilization Review jobs in Florida are:

What are popular job titles related to Remote Utilization Review jobs in Florida?

For Remote Utilization Review jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review jobs in Florida look for?

The top searched job categories for Remote Utilization Review jobs in Florida are:

What cities in Florida are hiring for Remote Utilization Review jobs?

Cities in Florida with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $65,722 per year, or $31.6 per hour.

Certified Coder & Auditing (TEXAS BASED ONLY - MUST RESIDE)

Dane Street, LLC

West Palm Beach, FL • On-site, Remote

$21.75 - $29.75/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 15 days ago

Job description

MUST RESIDE IN TEXAS AND HAVE CODING AND AUDITING EXPERIENCE. Counter Affidavit as well as Testimony experience is preferred.
Requirements
We are seeking an experienced CPC certified medical coder to perform coding audits, utilization reviews, audits and more. We are looking for someone who can provide litigation support including deposition and testimony services when needed. The ideal candidate must have strong Texas based coding experience and a thorough understanding of medical necessity, documentation compliance, and payer audit defense. Counter Affidavit experience is preferred.
Responsibilities:
• Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS)
• Conduct utilization reviews to determine medical necessity and documentation compliance
• Review and prepare demand packages and audit response materials
• Analyze records for payer disputes and recoupments
• Prepare written audit findings and defensible reports
• Provide expert support for depositions and testimony as needed
• Review E/M services under 2021+ guidelines
• Interpret CMS, LCD/NCD, and payer-specific policies
• Identify risk areas and compliance vulnerabilities
Required Qualifications:
• Active CPC certification through the American Academy of Professional Coders (AAPC)
• CPMA preferred
• Minimum 5 years of professional coding experience
• At least 3 years of Texas-based coding experience required
• Strong knowledge of Texas Medicaid (TMHP) and Texas commercial payer policies
• Prior audit and utilization review experience required
• Experience supporting legal cases, depositions, or expert testimony strongly preferred
• Excellent written documentation and reporting skills
• Ability to work independently and meet deadlines
This position may be part-time depending on the candidate's qualifications. Texas residency is a requirement.
Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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