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Remote Utilization Review Jobs in Boca Raton, FL

Guardian Recovery

UR COORDINATOR

Delray Beach, FL · On-site +1

$60K - $75K/yr

The Utilization Review Coordinator (UR Coordinator) is responsible to perform the process of utilization review to ensure appropriate reimbursement by third party payers. This includes managing ...

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 ...

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

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How much do remote utilization review jobs pay per hour?

As of Jul 6, 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 June 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 100% Remote job distribution, with an average salary of $83,458 per year, or $40.1 per hour.

Utilization Review Coordinator | Remote

Atlantic Health Strategies

Boca Raton, FL • On-site, Remote

$50K - $80K/yr

Full-time

Posted 6 days ago

Job description


About the Organization
Lotus Healthcare Billing is a behavioral health billing operation based in Boca Raton, Florida, supporting treatment programs through insurance authorization, utilization review, and payer communication. The team works closely with clinical staff to ensure that patients can access the levels of care they need, from detox through outpatient services.
The Opportunity
We are seeking a detail-oriented Utilization Review Coordinator to join the Lotus Healthcare Billing team. This full-time, remote role is well suited to someone who is organized, communicates clearly, and is comfortable managing a caseload where timelines directly affect patient care. A hybrid schedule with time in the Boca Raton office may be available for the right candidate. No prior utilization review experience is required. Training will be provided for the right candidate.
What You'll Do
  • Conduct daily phone contact with insurance companies to secure authorizations for behavioral health and substance use disorder treatment.
  • Manage a caseload of active authorizations, tracking timelines closely since they directly affect patient care.
  • Apply knowledge of SUD and behavioral health levels of care, including detox, residential, PHP, IOP, and outpatient, when communicating with payers.
  • Reference ASAM criteria and medical necessity standards to support authorization requests.
  • Use systems such as KIPU, Availity, or other payer portals to document and track review activity.
  • Communicate professionally and consistently with insurance representatives and internal clinical teams.
  • Work independently while staying aligned with program and compliance expectations.

Requirements
Requirements
  • High school diploma or equivalent required; associate's or bachelor's degree a plus.
  • Less than one year of relevant experience required; training provided for the right candidate.
  • Experience in utilization review, insurance authorization, or behavioral health billing preferred.
  • Familiarity with SUD/behavioral health levels of care (detox, residential, PHP, IOP, OP) is a strong plus.
  • Knowledge of ASAM criteria and medical necessity standards a plus.
  • Experience with KIPU, Availity, or payer portals preferred.
  • Strong organizational skills and attention to detail.
  • Clear, professional communication skills.
  • Comfortable working independently and managing a caseload.
  • Reliable home internet and a private, HIPAA-compliant workspace for remote work.

Benefits
Compensation and Schedule
  • Salary: $50,000 to $80,000 annually, commensurate with experience.
  • Schedule: Days, full-time, remote (hybrid option available for the right candidate).

This opportunity is posted by Atlantic Health Strategies on behalf of Lotus Healthcare Billing in Boca Raton, Florida.

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