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Remote Utilization Review Jobs in New Port Richey, FL

Elevance Health

Utilization Management Rep I (contract)

Tampa, FL · Remote

$35K - $40K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... The position is remote. The training will be onsite in the Tampa office for 1-2 weeks. * 5411 Sky ...

Risk Strategies

Senior Employee Benefits Analyst

Tampa, FL · On-site +1

$68K - $89K/yr

  • Medical

  • Dental

  • Vision

  • Life

*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 · Remote

$68K - $89K/yr

  • Medical

  • Dental

  • Vision

  • Life

*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 ...

FrankCrum

Senior 401k Retirement Plan Specialist

Clearwater, FL · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... remote opportunity! In this role, you will be serving as a subject matter expert for the design ... Provides senior-level oversight of day-to-day plan administration, including review of data ...

EverDriven

Account Executive, Georgia/Florida

Tampa, FL · Remote

$120K - $150K/yr

This is a remote role, but this Account Executive will service a territory within the state of ... utilization-based growth with field operations through proactive business reviews and ...

Strive Pharmacy

Systems Administrator - Tampa (Hybrid)

Tampa, FL · On-site +1

$85K - $95K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Tampa, FL (Hybrid - 3 days on-site, 2 days remote) Salary: $85,000 - $95,000 Travel: up to 25% Key ... reviews and remediate drift Business Application Administration - Serve as administrator for a ...

CVS Health

Nurse Clinical Operations - Registered Nurse

Tampa, FL · On-site +1

$29.10 - $62.32/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

This is a fully remote position * Candidates must live within a 50-mile radius of either our Orlando, FL, or Tampa, FL Specialy Pharmacy locations so they are able to come into the office in the ...

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Showing results 21-38

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 Aug 17, 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:

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:

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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 August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 15% Part Time, 4% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $78,333 per year, or $37.7 per hour.

Director, Actuarial Services

Avalon Administrative Services LLC

Tampa, FL • On-site, Remote

Full-time

Posted 9 days ago

Job description

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.

Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.

With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.

This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Director, Actuarial Services Position:

The Director, Actuarial Services is responsible for leading the organization's actuarial and healthcare analytics functions in support of strategic, financial, and operational objectives. This role directs the development and maintenance of actuarial models, financial forecasts, reserving methodologies, and risk analyses that support business performance and informed decision-making. Leveraging deep actuarial expertise and healthcare industry knowledge, the Director evaluates emerging trends, utilization patterns, medical cost drivers, and financial risks to provide actionable insights and recommendations.  

The Director, Actuarial Services partners closely with executive leadership and cross-functional stakeholders, including Finance, Health Analytics, Network Management, and Product teams, to support pricing strategies, financial forecasting, risk adjustment initiatives, and regulatory compliance. This position is responsible for communicating actuarial findings, financial risk exposure, and strategic recommendations to leadership while driving continuous improvement of actuarial methodologies, tools, data infrastructure, and reporting capabilities. Through the application of advanced analytics and actuarial principles, the Director supports organizational performance, financial sustainability, and data-driven decision-making.

This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

Director, Actuarial Services – Essential Functions and Responsibilities:

  • Direct the development and maintenance of actuarial models for all lines of businesses and products
  • Monitor program performance, researching reasons for variances and providing/implementing actionable plans
  • Oversee medical cost trend analysis, utilization reviews, and per-member-per-month (PMPM) projections
  • Own the reserving process, including incurred but not reported (IBNR) liability estimates, claims development triangles, and variance analyses
  • Ensure actuarial compliance with state and federal regulatory requirements
  • Partner with finance, health analytics, network management, and product teams to support pricing strategy and financial forecasting
  • Serve as the primary actuarial liaison with internal and external auditors
  • Direct the development of risk adjustment strategies and analytics
  • Provide executive leadership with clear, concise communication of actuarial findings, financial risk exposure, and strategic recommendations
  • Drive continuous improvement of actuarial models, tools, data infrastructure, and team workflows
  • Monitor industry trends, regulatory changes, and emerging healthcare cost drivers and communicate implications to leadership
  • Lead ad hoc analyses and deep dives as required.

Director, Actuarial Services – Minimum Qualifications:

  • Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related quantitative field
  • Associate of the Society of Actuaries (ASA) designation is required at minimum
  • Member in good standing with the American Academy of Actuaries (MAAA) required
  • 5+ years of actuarial experience, with at least 5 years in a health plan or managed care setting
  • Demonstrated expertise in healthcare actuarial pricing, reserving, or risk adjustment
  • Strong proficiency in actuarial and analytical tools (e.g., Excel/VBA, Tableau, SAS, R, Python, or similar)
  • Deep understanding of ACA regulations, CMS programs (Medicare Advantage, Medicaid)
  • Exceptional communication and presentation skills with the ability to convey complex actuarial concepts to non-actuarial executives and board members
  • Understanding of medical coding systems (ICD-10, CPT, HCPCS, DRG)
  • Strong analytical, critical thinking, and problem-solving skills
  • Excellent written and verbal communication skills

Director, Actuarial Services – Preferred Qualifications:

  • 10+ years of actuarial experience in health insurance, managed care environment
  • Experience with risk adjustment and risk transfer
  • Exposure to predictive modeling, machine learning applications in actuarial contexts, or health risk scoring
  • Experience working with large-scale data platforms (Snowflake, Databricks, AWS)
  • Experience with Tableau, Python or R for statistical analysis
  • Knowledge of value-based care models (ACOs, PCMH, bundled payments)
  • Understanding of HIPAA regulations and healthcare data governance practices


    • PM18


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