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Remote Utilization Review Jobs in New Port Richey, FL

LIBERTY DENTAL

Senior Staff Dentist

Tampa, FL · On-site +1

$175K - $185K/yr

Conduct retrospective utilization reviews and support provider behavior change initiatives ... Remote role with collaboration across national teams * High-impact role shaping clinical standards ...

Risk Strategies

Senior Employee Benefits Analyst

Tampa, FL · Remote

$68K - $89K/yr

*Please Note: This is remote position but based out of Tampa, FL *The Senior Employee Benefits ... Evaluate claims experience, utilization trends, and financial performance to identify risks ...

Risk Strategies

Senior Employee Benefits Analyst

Tampa, FL · On-site +1

$68K - $89K/yr

*Please Note: This is remote position but based out of Tampa, FL * The Senior Employee Benefits ... Evaluate claims experience, utilization trends, and financial performance to identify risks ...

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All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in New Port Richey, FL

Remote Utilization Review information

See New Port Richey, FL salary details

$19

$37

$61

How much do remote utilization review jobs pay per hour?

As of Jul 28, 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 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 New Port Richey, FL? The most popular types of Utilization Review jobs in New Port Richey, FL are:
What are popular job titles related to Remote Utilization Review jobs in New Port Richey, FL? For Remote Utilization Review jobs in New Port Richey, FL, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in New Port Richey, FL look for? The top searched job categories for Remote Utilization Review jobs in New Port Richey, FL are:
What cities near New Port Richey, FL are hiring for Remote Utilization Review jobs? 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 July 2026, with employment types broken down into 70% Full Time, 11% Part Time, and 19% Contract. Highlights an 43% Physical, 3% Hybrid, and 54% Remote job distribution, with an average salary of $78,333 per year, or $37.7 per hour.

Nurse Reviewer - Tampa, FL

Healthcare Quality Strategies, Inc.

Tampa, FL • Remote

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Posted 12 days ago

Job description

Nurse Reviewer
PT (20-30 hours week) – Remote Work Environment
Non-Exempt: $40.00 hour
Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely.
Essential Duties and Responsibilities:
  • Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies
  • Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines
  • Document evidence-based criteria applicable to specific contract requirements
  • Record and report screening results, including relevant referral questions, into a centralized database
  • Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity
  • Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations
  • Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards
Knowledge, Experience, Skills and Education:
  • Medical terminology, ICD-10, CPT and HCPCS
  • Clinical criteria (InterQual and MCG)
  • Utilization/Medical record review and chart abstraction
  • Current standards of medical practice
  • Comply with HIPAA/HITECH laws and regulations
Experience in:
  • At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred)
  • Experience performing medical record review, audit for federal or state contracts
  • Knowledge and experience of Medicare and Medicaid policy
  • Proficiency with Microsoft Office (Word, Excel, and Outlook)
  • Proficiency with Adobe PDF files and features
  • Generating accurate, timely, and understandable correspondence
  • Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG)
Skills Requirements include:
  • Professional interpersonal skills; ability to interact with providers, physicians and peers
  • Solid analytical, assessment and documentation skills
  • Effective written and verbal communication, both internally and externally
  • Strong attention to detail
  • Strong attention to deadlines
  • Organizational skills including effective time management, priority setting and process improvement
  • Ability to work independently and as a member of a team
  • Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations
Educational Background:
  • BSN with active RN licensure in good standing
Physical Demands:
Remote Work, Prolonged Sitting, Screen Exposure
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD amp;D, voluntary life/AD amp;D, 401k
For immediate consideration, please apply via the HQSI Careers Page at: www.hqsi.org gt; Careers gt; Current Employment Opportunities
EOE: Minorities/Females/Disabled/Veterans
Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace
Healthcare Quality Strategies, Inc. is an E-Verify Employer

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