Millersville, MD · On-site +1
$189K - $238K/yr
Remote Type: Part-Time *This position is contingent upon the successful award of the associated ... Minimum Requirements: * 10+ years clinical practice; experience in peer review, utilization review ...
Millersville, MD · On-site +1
$189K - $238K/yr
Remote Type: Part-Time *This position is contingent upon the successful award of the associated ... Minimum Requirements: * 10+ years clinical practice; experience in peer review, utilization review ...
Nottingham, MD · On-site +1
$182K - $248K/yr
This role is fully remote and must be located within the 50 U.S. states. Standard working hours are ... Prior experience in Utilization Management processes and the medical necessity review lifecycle is ...
Nottingham, MD · On-site +1
$182K - $248K/yr
This role is fully remote and must be located within the 50 U.S. states. Standard working hours are ... Prior experience in Utilization Management processes and the medical necessity review lifecycle is ...
Nottingham, MD · On-site +1
$280K - $345K/yr
Perform clinical reviews (i.e., part A, B, appeals, quality of care) and conduct peer to peer ... Comfort with ambiguity and a love for problem solving. #LI-Remote Salary Range: $280,000 - $345,000 ...
Nottingham, MD · On-site +1
$280K - $345K/yr
Perform clinical reviews (i.e., part A, B, appeals, quality of care) and conduct peer to peer ... Comfort with ambiguity and a love for problem solving. #LI-Remote Salary Range: $280,000 - $345,000 ...
Pasadena, MD · Remote
$59.25 - $71/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Pasadena, MD · Remote
$59.25 - $71/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Baltimore, MD · On-site +1
$80K - $95K/yr
A minimum of three (3) or more years' experience in medical/utilization medical record review ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...
Baltimore, MD · On-site +1
$80K - $95K/yr
A minimum of three (3) or more years' experience in medical/utilization medical record review ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...
A minimum of three (3) or more years' experience in medical/utilization medical record review ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...
A minimum of three (3) or more years' experience in medical/utilization medical record review ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...
Experience: 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review. Licenses/Certifications Upon Hire Required: * RN - ...
Experience: 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review. Licenses/Certifications Upon Hire Required: * RN - ...
... Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG * Experience working with Commercial and Federal Employee Program employee group member and Medicare/Medicaid ...
... Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG * Experience working with Commercial and Federal Employee Program employee group member and Medicare/Medicaid ...
Washington, DC Experience: 5 years clinically related experience working in an acute care setting, and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG
Washington, DC Experience: 5 years clinically related experience working in an acute care setting, and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG
Pasadena, MD · On-site +1
$58.25 - $70.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Pasadena, MD · On-site +1
$58.25 - $70.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Experience: 5 years' clinically related experience working in Discharge Coordination and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG; previous post-acute ...
Experience: 5 years' clinically related experience working in Discharge Coordination and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG; previous post-acute ...
Nottingham, MD · Remote
$63K - $95K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Nottingham, MD · Remote
$63K - $95K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Nottingham, MD · Remote
$63K - $95K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
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Nottingham, MD · Remote
$63K - $95K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Three (3) years Medical Review, Utilization Management, Nurse Auditor/Revenue Integrity, and/or Appeal and Grievance review at CareFirst BlueCross BlueShield, or similar Managed Care organization or ...
Three (3) years Medical Review, Utilization Management, Nurse Auditor/Revenue Integrity, and/or Appeal and Grievance review at CareFirst BlueCross BlueShield, or similar Managed Care organization or ...
Drive accountability through routine performance scorecards, operational reviews, and metric-based ... utilization, revenue cycle performance, and cost structures. * Mentor and support operational ...
Drive accountability through routine performance scorecards, operational reviews, and metric-based ... utilization, revenue cycle performance, and cost structures. * Mentor and support operational ...
Baltimore, MD · Remote
$127K - $142K/yr
... reviews, SLA tracking, and QBR preparation - in partnership with the Business Director * Route tasks to talent, factoring real-time utilization and SLAs; implement automated alerts to proactively ...
Baltimore, MD · Remote
$127K - $142K/yr
... reviews, SLA tracking, and QBR preparation - in partnership with the Business Director * Route tasks to talent, factoring real-time utilization and SLAs; implement automated alerts to proactively ...
Three (3) years of clinically related experience working in Medical Review, Utilization Management, or other RN direct patient care or health insurance payor experience. Preferred Qualifications:
Three (3) years of clinically related experience working in Medical Review, Utilization Management, or other RN direct patient care or health insurance payor experience. Preferred Qualifications:
Nottingham, MD · On-site +1
$95K - $120K/yr
The Post-Acute UM Supervisor will oversee utilization management activities across post-acute ... reviews, and clinical oversight. This role will partner with medical leadership to implement ...
Nottingham, MD · On-site +1
$95K - $120K/yr
The Post-Acute UM Supervisor will oversee utilization management activities across post-acute ... reviews, and clinical oversight. This role will partner with medical leadership to implement ...
Three (3) years of clinically related experience working in Medical Review, Utilization Management, or other RN direct patient care or health insurance payor experience. Preferred Qualifications:
Three (3) years of clinically related experience working in Medical Review, Utilization Management, or other RN direct patient care or health insurance payor experience. Preferred Qualifications:
... Utilization Management, Payment Integrity, and Compliance to improve process efficiency, support ... Working under the direction of the Director, Medical Review and Appeals, the Business Consultant ...
... Utilization Management, Payment Integrity, and Compliance to improve process efficiency, support ... Working under the direction of the Director, Medical Review and Appeals, the Business Consultant ...
$20.52 - $24.67
2% of jobs
$24.67 - $28.82
9% of jobs
$31.66 is the 25th percentile. Wages below this are outliers.
$28.82 - $32.97
21% of jobs
The median wage is $36.33 / hr.
$32.97 - $37.12
23% of jobs
$37.12 - $41.27
13% of jobs
$44.50 is the 75th percentile. Wages above this are outliers.
$41.27 - $45.42
10% of jobs
$45.42 - $49.57
8% of jobs
$49.57 - $53.72
5% of jobs
$53.72 - $57.87
5% of jobs
$57.87 - $62.02
2% of jobs
$62.02 - $66.17
2% of jobs
$20
$40
$66
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.
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.
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.
$189K - $238K/yr
Part-time
Posted 29 days ago
Sourced by ZipRecruiter
Business management consulting
1 - 10 Employees
Millersville, MD, US
2017
