Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health. * Working knowledge of Workers' Compensation Medical Treatment Guidelines ...
Quick apply
Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health. * Working knowledge of Workers' Compensation Medical Treatment Guidelines ...
Quick apply
Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health. * Working knowledge of Workers' Compensation Medical Treatment Guidelines ...
Those fully remote associates residing in states where service is required by contract, law, or ... When necessary, cases are escalated to the Medical Director for further review. The reviewer ...
Those fully remote associates residing in states where service is required by contract, law, or ... When necessary, cases are escalated to the Medical Director for further review. The reviewer ...
Washington, DC ยท Remote
$36 - $42/hr
Our team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: help healthcare get better. This position is 100% remote , offering the ...
Quick apply
Washington, DC ยท Remote
$36 - $42/hr
Our team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: help healthcare get better. This position is 100% remote , offering the ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ...
Washington, DC ยท On-site +1
Role Overview Under the direction of the Supervisor, the Behavioral Health Utilization Management ... For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ...
Washington, DC ยท On-site +1
Role Overview Under the direction of the Supervisor, the Behavioral Health Utilization Management ... For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ...
Washington, DC ยท Remote
Those fully remote associates residing in states where service is required by contract, law, or ... Strong understanding of utilization review processes, including medical necessity criteria, care ...
Washington, DC ยท Remote
Those fully remote associates residing in states where service is required by contract, law, or ... Strong understanding of utilization review processes, including medical necessity criteria, care ...
Washington, DC ยท On-site +1
$27.02 - $36.78/hr
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ... Compensation plans for physicians, licensed nurse reviewers, staff, and consultants who conduct ...
Washington, DC ยท On-site +1
$27.02 - $36.78/hr
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ... Compensation plans for physicians, licensed nurse reviewers, staff, and consultants who conduct ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Millersville, MD ยท On-site +1
$115K - $137K/yr
Remote Status: Part-time About J29 J29 is an employee centered healthcare management consulting ... Knowledge of drug utilization review, medication safety principles, and evidence-based clinical ...
Millersville, MD ยท On-site +1
$115K - $137K/yr
Remote Status: Part-time About J29 J29 is an employee centered healthcare management consulting ... Knowledge of drug utilization review, medication safety principles, and evidence-based clinical ...
Fairfax, VA ยท Remote
$80 - $110/hr
BCBA (Board Certified Behavior Analyst) - Part-time $80110/hr Flexible Schedule Hybrid (Remote + In ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
Quick apply
Fairfax, VA ยท Remote
$80 - $110/hr
BCBA (Board Certified Behavior Analyst) - Part-time $80110/hr Flexible Schedule Hybrid (Remote + In ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
Washington, DC ยท On-site +1
$309K - $413K/yr
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.
Washington, DC ยท On-site +1
$309K - $413K/yr
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.
Washington, DC ยท On-site +1
$309K - $413K/yr
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.
Washington, DC ยท On-site +1
$309K - $413K/yr
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.
Millersville, MD ยท On-site +1
Remote About J29 J29 is an employee centered healthcare management consulting company that ... Requires 5-7 years work experience (this could be a combination of clinical and utilization review ...
Millersville, MD ยท On-site +1
Remote About J29 J29 is an employee centered healthcare management consulting company that ... Requires 5-7 years work experience (this could be a combination of clinical and utilization review ...
Linthicum Heights, MD ยท Remote
$90K - $110K/yr
Experience with mental health and substance abuse utilization review processes is an asset ... remote approach. Our work culture emphasizes support, growth, and community, making it an ideal ...
Linthicum Heights, MD ยท Remote
$90K - $110K/yr
Experience with mental health and substance abuse utilization review processes is an asset ... remote approach. Our work culture emphasizes support, growth, and community, making it an ideal ...
Linthicum Heights, MD ยท Remote
$90K - $110K/yr
Experience with mental health and substance abuse utilization review processes is an asset ... remote approach. Our work culture emphasizes support, growth, and community, making it an ideal ...
Linthicum Heights, MD ยท Remote
$90K - $110K/yr
Experience with mental health and substance abuse utilization review processes is an asset ... remote approach. Our work culture emphasizes support, growth, and community, making it an ideal ...
Washington, DC ยท On-site +1
Along with excellent benefits, McGuireWoods offers most employees a hybrid remote option allowing ... Lead the annual benefits renewal process, including plan design evaluation, utilization review ...
Washington, DC ยท On-site +1
Along with excellent benefits, McGuireWoods offers most employees a hybrid remote option allowing ... Lead the annual benefits renewal process, including plan design evaluation, utilization review ...
VA ยท Remote
Review workflows, tables, fields, business rules, UI policies, ACLs, integrations, reports, and ... Capacity, demand, utilization, and workload management * Configure ServiceNow Cost Management ...
Quick apply
VA ยท Remote
Review workflows, tables, fields, business rules, UI policies, ACLs, integrations, reports, and ... Capacity, demand, utilization, and workload management * Configure ServiceNow Cost Management ...
Fairfax, VA ยท On-site +1
$80 - $110/hr
... Hybrid (Remote + In-person) A rare opportunity to join a growing ABA practice as an early team ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
Fairfax, VA ยท On-site +1
$80 - $110/hr
... Hybrid (Remote + In-person) A rare opportunity to join a growing ABA practice as an early team ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
Fairfax, VA ยท On-site +1
$80 - $110/hr
BCBA (Board Certified Behavior Analyst) - Part-time $80-110/hr Flexible Schedule Hybrid (Remote ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
Fairfax, VA ยท On-site +1
$80 - $110/hr
BCBA (Board Certified Behavior Analyst) - Part-time $80-110/hr Flexible Schedule Hybrid (Remote ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
$22.90 - $27.53
2% of jobs
$27.53 - $32.16
9% of jobs
$35.33 is the 25th percentile. Wages below this are outliers.
$32.16 - $36.79
21% of jobs
The median wage is $40.54 / hr.
$36.79 - $41.42
23% of jobs
$41.42 - $46.05
13% of jobs
$49.65 is the 75th percentile. Wages above this are outliers.
$46.05 - $50.68
10% of jobs
$50.68 - $55.31
8% of jobs
$55.31 - $59.94
5% of jobs
$59.94 - $64.58
5% of jobs
$64.58 - $69.21
2% of jobs
$69.21 - $73.84
2% of jobs
$22
$45
$73
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.
For Remote Utilization Review jobs in Bethesda, MD, the most frequently searched job titles are:
The top searched job categories for Remote Utilization Review jobs in Bethesda, MD are:
Cities near Bethesda, MD with the most Remote Utilization Review job openings:

Washington, DC โข Remote
Contractor
Posted 6 days ago
iMPROve Health is seeking an RN Reviewer (Workers' Compensation Utilization Review) to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type.
BENEFITS:
OTHER REQUIREMENTS:
EOE/VET/Disability