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Remote Utilization Review Jobs in Boca Raton, FL

Aspirion

Clinical Nurse Specialist

Delray Beach, FL · Remote

$68K - $100K/yr

Certification in Case Management or Utilization Review preferred Core expectations * Demonstrate ... 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

Certification in Case Management or Utilization Review preferred Core expectations * Demonstrate ... US remote-based colleagues are not permitted to work from a location outside of the United States ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Hollywood, FL · On-site +1

$52.25 - $63.75/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

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All JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Boca Raton, FL

Remote Utilization Review information

See Boca Raton, FL salary details

$20

$40

$65

How much do remote utilization review jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for remote utilization review 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 in the Remote Utilization Review position, and why are they important?

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 typical day look like for someone in a Remote Utilization Review role?

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 job?

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 Boca Raton, FL? The most popular types of Utilization Review jobs in Boca Raton, FL are:
What are popular job titles related to Remote Utilization Review jobs in Boca Raton, FL? For Remote Utilization Review jobs in Boca Raton, FL, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Boca Raton, FL look for? The top searched job categories for Remote Utilization Review jobs in Boca Raton, FL are:
What cities near Boca Raton, FL are hiring for Remote Utilization Review jobs? Cities near Boca Raton, FL with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Boca Raton, FL as of May 2026, with employment types broken down into 79% Full Time, 5% Part Time, and 16% Contract. Highlights an 100% Remote job distribution, with an average salary of $83,458 per year, or $40.1 per hour.

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.