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Remote Utilization Review Jobs in Elizabeth, NJ (NOW HIRING)

HURC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

Hurc LLC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

Med-Metrix

Physician Advisor - Remote

Parsippany, NJ · On-site +1

Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred * Physician Advisor Sub-Specialty Certification by the American Board of ...

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All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Elizabeth, NJ

Remote Utilization Review information

See Elizabeth, NJ salary details

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$69

How much do remote utilization review jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for remote utilization review in Elizabeth, NJ is $42.55, according to ZipRecruiter salary data. Most workers in this role earn between $33.61 and $48.85 per hour, depending on experience, location, and employer.

What is a remote utilization review?

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 does a remote utilization review do?

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 are the key skills and qualifications needed to thrive in remote utilization review?

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 are popular job titles related to Remote Utilization Review jobs in Elizabeth, NJ?

For Remote Utilization Review jobs in Elizabeth, NJ, the most frequently searched job titles are:

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Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Elizabeth, NJ as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $88,511 per year, or $42.6 per hour.

Sr Hospitalist Clinical Reviewer - Remote

YO AI Labs

New York, NY • Remote

$70 - $100/hr

Full-time

Posted 2 days ago

New

Job description

Senior Hospitalist Clinical Reviewer

Job Type: Contractor
Location: Remote

Job Overview

We are seeking experienced Senior Hospitalist Clinical Reviewers to support a high-impact project focused on inpatient clinical quality, documentation accuracy, and medical review. In this role, you will apply your hospitalist expertise and clinical judgment to evaluate inpatient cases, identify complex or ambiguous clinical scenarios, and provide clear, well-reasoned feedback.

This opportunity is ideal for experienced physicians with a strong background in hospital medicine, inpatient quality, medical auditing, clinical documentation, and quality assurance.

Key Responsibilities
  • Review inpatient cases for clinical quality, appropriate care, and documentation accuracy.
  • Evaluate clinical decisions and identify potential quality, documentation, or care concerns.
  • Apply advanced clinical judgment to complex, unusual, or ambiguous inpatient cases.
  • Provide clear and concise explanations supporting clinical review decisions.
  • Assess medical records, clinical documentation, and relevant supporting information.
  • Identify inconsistencies, gaps, or areas requiring clarification within clinical documentation.
  • Apply established clinical standards, guidelines, and quality frameworks when appropriate.
  • Contribute to the development and improvement of clinical review guidelines and quality standards.
  • Collaborate with project teams to resolve challenging clinical cases and review questions.
  • Maintain consistent, accurate, and high-quality review standards across assigned cases.
  • Work independently while meeting project timelines and quality expectations.
Required Qualifications
  • MD or DO degree.
  • 10+ years of attending-level hospitalist experience.
  • Strong experience in inpatient medicine and hospital-based clinical care.
  • Demonstrated experience with inpatient quality, clinical documentation review, medical auditing, or quality assurance.
  • Excellent clinical judgment and ability to evaluate complex or ambiguous cases.
  • Strong written and verbal communication skills.
  • Ability to clearly articulate clinical reasoning and support review decisions.
  • Strong attention to detail and ability to analyze medical records comprehensively.
  • Ability to work independently in a remote environment.
Preferred Qualifications
  • Experience leading or contributing to hospital quality improvement programs.
  • Experience with clinical documentation improvement (CDI).
  • Experience with medical coding, utilization review, or physician audit processes.
  • Experience developing or reviewing clinical quality standards.
  • Familiarity with hospital quality metrics and inpatient quality initiatives.
  • Previous experience mentoring physicians or participating in physician peer review.
Core Skills
  • Inpatient Quality
  • Quality Assurance
  • Medical Auditing
  • Hospital Medicine / Hospitalist Practice
  • Clinical Judgment
  • Clinical Documentation Review
  • Medical Record Review
  • Quality Improvement
  • Critical Thinking
  • Written and Verbal Communication
  • Attention to Detail