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Remote Utilization Review Jobs in Keyport, 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 ...

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Remote Utilization Review information

See Keyport, NJ salary details

$22

$43

$71

How much do remote utilization review jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for remote utilization review in Keyport, NJ is $43.66, according to ZipRecruiter salary data. Most workers in this role earn between $34.52 and $50.14 per hour, depending on experience, location, and employer.

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

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

What job categories do people searching Remote Utilization Review jobs in Keyport, NJ look for?

The top searched job categories for Remote Utilization Review jobs in Keyport, NJ are:

What cities near Keyport, NJ are hiring for Remote Utilization Review jobs?

Cities near Keyport, NJ with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Keyport, NJ as of August 2026, with employment types broken down into 94% Full Time, and 6% Part Time. Highlights an 6% In-person, and 94% Remote job distribution, with an average salary of $90,805 per year, or $43.7 per hour.

Associate Medical Director, Utilization Management

Oscar Health

New York, NY • Remote

$240K - $315K/yr

Full-time

Re-posted 17 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

257th of 308 rated insurance

Job description

Hi, we're Oscar. We're hiring an Associate Medical Director to join our Utilization Management Team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

This role determines the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This role also influences departmental strategy, leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards.

You will report into the Senior Medical Director.

Work Location: This is a remote position, open to candidates holding an active medical license in Florida, Arizona or North Carolina, OR to physicians who hold an IMLC compact license. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $240,120 - $315,157 annually. You are also eligible for employee benefits including a performance bonus, 401K with immediate vesting, and unlimited PTO.

Responsibilities:

  • Provide timely medical reviews that meet Oscar's stringent quality parameters.

  • Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.

  • Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level).

  • Use correct templates for documenting decisions during case review.

  • Receive and review escalated reviews.

  • Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.

  • Manage direct reports and oversee their performance.

  • Provide oversight to ensure the team meets turn-around times for clinical reviews.

  • Collaborate with other departments on Utilization Management Operations.

  • Lead key projects and drive initiatives to successful completion.

  • Other duties as assigned

  • Compliance with all applicable laws and regulations.ocus on the main or important responsibilities))

Requirements:

  • Board certification as an MD or DO with a current unrestricted license to practice medicine is required.

  • 3+ years of clinical practice

  • 2+ years of utilization review experience in a managed care plan (health care industry)

Bonus points:

  • Licensure in multiple Oscar states

  • Experience with care management within the health insurance industry.

  • Willing and able to obtain additional state licensure as business needs, with Oscar's support

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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