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Remote Utilization Review Jobs in Boca Raton, FL

NationsBenefits, LLC

Associate Account Manager

Plantation, FL · On-site +1

$122K - $127K/yr

Open to remote & onsite/hybrid in Plantation, FL Primary Responsibilities: 1. Client Account ... utilization. * Prepare and present Monthly Reports, Quarterly Business Reviews (QBRs), and ad hoc ...

NationsBenefits

Associate Account Manager

Plantation, FL · On-site +1

$122K - $127K/yr

Open to remote & onsite/hybrid in Plantation, FL Primary Responsibilities: 1. Client Account ... utilization. * Prepare and present Monthly Reports, Quarterly Business Reviews (QBRs), and ad hoc ...

NationsBenefits

Account Manager

Plantation, FL · On-site +1

Open to remote & onsite in Plantation, FL Primary Responsibilities: 1. Client Account Management ... utilization. * Prepare and present Monthly Reports, Quarterly Business Reviews (QBRs), and ad hoc ...

NationsBenefits, LLC

Account Manager

Plantation, FL · Remote

Open to remote & onsite in Plantation, FL Primary Responsibilities: 1. Client Account Management ... utilization. * Prepare and present Monthly Reports, Quarterly Business Reviews (QBRs), and ad hoc ...

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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 July 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 Management, Clinical QA Supervisor

Utilization Management, Clinical QA Supervisor

Dane Street, LLC

Loxahatchee Groves, FL • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted yesterday

Be an early applicant

Job description

The Clinical QA Supervisor is responsible for the oversight of the review of Physician reports and accompanying medical records to ensure that the report is complete, accurate, and consistent with medical evidence.

Oversight of QA staff

  • Ensure appropriate QA staff are assigned to each file to designate file handling responsibilities amongst the team.
  • Supervise the assigned staff and manage the File Review Board to ensure a timely and accurate process of each file.
  • Provide details of board reviews to managers to ensure efficiency and productivity of staff.
  • Assist in identifying & correcting staff performance including promotions, discipline, coaching and termination of staff.
  • Assist in hiring qualified candidates for QA open positions.

Ensure that all QA staff adhere to and meet their specific job duties including but not limited to:

    • Following up with Physicians for outstanding reports
    • Reviewing received reports for accuracy
    • Delivering completed reports back to all applicable parties
    • Following all client-specific instructions
  • Actively participate in issue resolution by working with the required QA, physicians, account managers, and/or other related parties.
  • Ensure referrals meet the client-directed Turn Around Time (TAT).
  • Act as the liaison between the reviewer, team member and client regarding the process or status of the file.
  • Other duties & special projects, as assigned and based on business needs.

Requirements

EDUCATION/CREDENTIALS:

An Associate’s Degree or Bachelor’s Degree is preferred.

RN licensure required

JOB RELEVANT EXPERIENCE:

Medical peer review or healthcare industry knowledge required.

Business experience in a healthcare and/or insurance setting is preferred.

JOB RELATED SKILLS/COMPETENCIES:

Present exceptional communication skills with a clear understanding of company business lines. The ability to apply critical thinking, manage time efficiently and meet specific deadlines. Computer literacy and typing skills are essential.

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.