Ridgeland, MS · On-site +1
$62K - $96K/yr
... s) through utilization of established guidelines to determine appropriate medical treatment ... to review and research conducted utilizing nationally accepted practice parameters. This position ...
Ridgeland, MS · On-site +1
$62K - $96K/yr
... s) through utilization of established guidelines to determine appropriate medical treatment ... to review and research conducted utilizing nationally accepted practice parameters. This position ...
$20.26 - $24.36
2% of jobs
$24.36 - $28.46
9% of jobs
$31.26 is the 25th percentile. Wages below this are outliers.
$28.46 - $32.56
21% of jobs
The median wage is $35.87 / hr.
$32.56 - $36.65
23% of jobs
$36.65 - $40.75
13% of jobs
$43.94 is the 75th percentile. Wages above this are outliers.
$40.75 - $44.85
10% of jobs
$44.85 - $48.95
8% of jobs
$48.95 - $53.05
5% of jobs
$53.05 - $57.14
5% of jobs
$57.14 - $61.24
2% of jobs
$61.24 - $65.34
2% of jobs
$20
$40
$65
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.
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.
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.
The most popular types of Utilization Review jobs in Mississippi are:
For Remote Utilization Review jobs in Mississippi, the most frequently searched job titles are:
The top searched job categories for Remote Utilization Review jobs in Mississippi are:
Cities in Mississippi with the most Remote Utilization Review job openings:
$62K - $96K/yr
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 13 days ago
FCCI is guided by our core values of Loyalty, Integrity, Vision, Excellence and Service. These are the principles and behaviors that guide how we support and trust one another, build our teams, cultivate leaders and create a company that feels like family. If these are your values, we’d like you to join our team.
We are seeking a licensed Registered Nurse to provide telephonic case management on assigned workers’ compensation claims. The selected new hire will provide coordination and evaluation of medical care to assigned caseload for the purpose of expediting claims handling. He/she will assist with oversight of necessary cost-effective quality medical treatment and work collaboratively with the adjuster for resolution of injury and/or return to work. In addition, this person will develop an initial plan outlining the action the case manager will take to ensure timely resolution of injury(s) through utilization of established guidelines to determine appropriate medical treatment, evaluate medical necessity in conjunction with the adjuster, and monitor progress/response to treatment. Utilize your medical expertise and critical thinking skills to make recommendations on alternative care pursuant to review and research conducted utilizing nationally accepted practice parameters.
This position can be hybrid and based out of our home office in Sarasota, FL, any of our regional offices, or remote.
In exchange for your talents, FCCI offers competitive salaries and an excellent benefits package which includes:
The salary range for this position is $62,419-$96,126 annually. This salary range is an estimate and the actual salary will vary based on applicant’s education, experience, knowledge, skills, and abilities.
We are an Equal Employment Opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
Please apply via our website at www.fcci-group.com.
Drug Free Workplace (*Pre-employment drug screen is conducted for all positions)
Sourced by ZipRecruiter
Insurance services
501 - 1,000 Employees
Sarasota, FL, US
1959