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Remote Utilization Review Jobs in New Port Richey, FL

HandsOn Global Management

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UM Review Nurse

Tampa, FL · Remote

$36 - $40/hr

Performs prospective, concurrent, and retrospective inpatient and/or outpatient utilization reviews (UR) using evidence-based guidelines, policies and nationally recognized clinical criteria, and ...

Toney Healthcare

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Supervisor, Utilization Management & Appeals

Tampa, FL · Remote

$50 - $60/hr

Review case data for completeness, accuracy, and regulatory alignment prior to submission ... Experience managing or supporting remote clinical teams. * Familiarity with Medicare, Medicaid, and ...

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

Experience with DME, utilization review, EMRs, care management platforms, and Microsoft Office ... This is a fully remote position with typical business hours; however, there may be instances when ...

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

Experience with DME, utilization review, EMRs, care management platforms, and Microsoft Office ... This is a fully remote position with typical business hours; however, there may be instances when ...

NTT DATA Services

BPO Senior Manager

Tampa, FL · Remote

$93K/yr

Lead, coach, and develop a team of Clinical Reviewers responsible for appeals and utilization ... Remote employees must adhere to all technical support procedures and protocols. * Chronic ...

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Remote Utilization Review information

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How much do remote utilization review jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for remote utilization review in New Port Richey, FL is $37.66, according to ZipRecruiter salary data. Most workers in this role earn between $29.76 and $43.27 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 the most commonly searched types of Utilization Review jobs in New Port Richey, FL?

The most popular types of Utilization Review jobs in New Port Richey, FL are:

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For Remote Utilization Review jobs in New Port Richey, FL, the most frequently searched job titles are:

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The top searched job categories for Remote Utilization Review jobs in New Port Richey, FL are:

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Cities near New Port Richey, FL with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in New Port Richey, FL as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $78,333 per year, or $37.7 per hour.

UM Review Nurse

Tampa, FL • Remote

HandsOn Global Management
See more jobs at HandsOn Global Managementexternal

$36 - $40/hr

Full-time

Medical, PTO

Posted 22 days ago

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Job description

PURPOSE AND SCOPE:

The UM Nurse Reviewer is responsible for the medical necessity review of outpatient services that

require prior authorization, and /or management of concurrent inpatient admissions. The medical

necessity review process includes assessment and interpretation of plan specific benefits, medical

criteria, and clinical documentation.

PRINCIPAL RESPONSIBILITIES AND DUTIES

• Performs prospective, concurrent, and retrospective inpatient and/or outpatient utilization reviews

(UR) using evidence-based guidelines, policies and nationally recognized clinical criteria, and internal

policies and procedures.

• Evaluates severity of illness and intensity of service of member’s needs at time of inpatient

admission utilizing approved criteria.

• Triage and prioritize cases and other assigned duties to meet CMS turnaround time standards.

• Prepare and escalate cases to MDs for review when appropriate.

• Demonstrates effective communication methods and skills, using lines of authority appropriately.

• Establishes a relationship with providers to determine/provide needed services to member.

• Maintains accurate record of UR activities.

• Regular attendance is required as employee works as part of a team & requires interaction with

medical staff and clients.

• Adheres to quality standards and confidentiality policies and procedures.

• Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.

• Adapts to changes in policies, procedures, new techniques, and additional responsibilities.


CUSTOMER SERVICE:

• Responsible for driving the HealthOps culture through values and customer service standards.

• Accountable for outstanding customer service to all external and internal contacts.

• Develops and maintains positive relationships through effective and timely communication.

• Takes initiative and action to respond, resolve and follow up regarding customer service issues with all

customers in a timely manner.


EDUCATION, EXPERIENCE AND REQUIRED SKILLS:

• Licensed RN or LPN required.

• Minimum of two to three years varied clinical experience required.

• Managed care experience preferred.

• An equivalent combination of education, training, and experience.

• Ability to read and interpret documents and calculate figures and amounts.

• Excellent oral and written communication skills including good grammar, voice and diction.

• Proficient in MS Office with basic computer and keyboarding skills.

• Excellent customer service skills (friendly, courteous and helpful).

• InterQual experience helpful.

Company Description

HandsOn Global Management (“HGM”) is a hybrid family office / PE fund / technology incubator focused on building innovative companies and driving synergies within our portfolio. We specialize in technology platforms, analytics and business process services.

Headquartered in Santa Monica, CA, HandsOn Global Management (“HGM”) manages a number of funds and investments in partnership with some of the world’s largest investment banks, private equity groups and global financial institutions. Over the last decade, HGM has completed several acquisitions, integrated them and taken some public. Companies acquired and controlled by HGM employ over 17,000 people in the Americas, EMEA, and Asia, and have over 50% of the Fortune 100® as customers.

HGM’s main focus is on acquiring synergetic assets in U.S. and emerging markets, which yield above-market returns. To achieve this goal, HGM invests in companies with strong fundamentals and significant performance improvement potential, where the HGM team can apply their hands-on approach to managing portfolio companies, as well as their investment discipline and technology to increase the overall value proposition of each portfolio company.