Texarkana, TX · Remote
$14.25 - $19.50/hr
Reviews and makes sure all documentation received meets insurance guidelines * Contacts Doctors ... Remote Employees must meet equipment/connection/software qualifications below Education and ...
Texarkana, TX · Remote
$14.25 - $19.50/hr
Reviews and makes sure all documentation received meets insurance guidelines * Contacts Doctors ... Remote Employees must meet equipment/connection/software qualifications below Education and ...
Ashdown, AR · Remote
$17.75 - $23.25/hr
While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred
Ashdown, AR · Remote
$17.75 - $23.25/hr
While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred
TX · Remote
$17.75 - $23.25/hr
While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred
TX · Remote
$17.75 - $23.25/hr
While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred
$19.75 - $23.74
2% of jobs
$23.74 - $27.74
9% of jobs
$30.47 is the 25th percentile. Wages below this are outliers.
$27.74 - $31.73
21% of jobs
The median wage is $34.96 / hr.
$31.73 - $35.72
23% of jobs
$35.72 - $39.72
13% of jobs
$42.82 is the 75th percentile. Wages above this are outliers.
$39.72 - $43.71
10% of jobs
$43.71 - $47.70
8% of jobs
$47.70 - $51.70
5% of jobs
$51.70 - $55.69
5% of jobs
$55.69 - $59.69
2% of jobs
$59.69 - $63.68
2% of jobs
$19
$39
$63
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.
Cities near Ashdown, AR with the most Remote Utilization Review job openings:
Texarkana, TX • Remote
6.9
Based on 273 frontline employees who took The Breakroom Quiz
453rd of 893 rated healthcare providers
People enjoy working here
Recommended by parents
Respectful managers
Uninterrupted breaks
$14.25 - $19.50/hr
Full-time
Re-posted 11 days ago
The Enteral CSR aids in all Customer Service functions of order entry/paperwork acquisition for insurance guidelines and review while also abiding by the procedures set forth by management within the Enteral business.
Job Responsibilities:
Education and Experience:
Physical Demands:
The employee must occasionally lift and/or move up to 10 pounds.
Remote Equipment Requirements:
This position requires use of your own equipment.
Helpful Link:
Connecting a 2nd monitor to a laptop:How to connect second monitor to laptop
Hardware Requirements
Software Requirements
Connectivity Requirements
Sourced by ZipRecruiter
Lincare's mission is to set the standard for excellence, transforming the way respiratory care is delivered in the home. We are inspired by a vision to enable patients with chronic conditions to remain engaged in life, with the peace of mind that we are caring for them. Lincare is a dynamic, growing company with over 1,000 locations in 49 states, employing over 13,000 people who share our corporate vision for quality care and service.
Health care and social assistance
10,000+ Employees
Clearwater, FL, US
1987
