Baltimore, MD · Remote
$20 - $24/hr
Supports the Utilization Management clinical teams by assisting with non-clinical administrative ... Reviews authorization requests for initial determination and/or triages for clinical review and ...
Quick apply
Baltimore, MD · Remote
$20 - $24/hr
Supports the Utilization Management clinical teams by assisting with non-clinical administrative ... Reviews authorization requests for initial determination and/or triages for clinical review and ...
Baltimore, MD · Remote
$20 - $24/hr
Supports the Utilization Management clinical teams by assisting with non-clinical administrative ... Reviews authorization requests for initial determination and/or triages for clinical review and ...
Quick apply
Baltimore, MD · Remote
$20 - $24/hr
Supports the Utilization Management clinical teams by assisting with non-clinical administrative ... Reviews authorization requests for initial determination and/or triages for clinical review and ...
Utilizing key principles of utilization management, the Utilization Review Specialist (RN) will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care ...
Utilizing key principles of utilization management, the Utilization Review Specialist (RN) will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care ...
Washington, DC · Remote
$25.90 - $37.30/hr
You'll utilize clinical knowledge and critical thinking to research and review IP UM requests ... for all work. #LI-Remote Pay ranges vary based on the candidate's work location. The expected ...
Washington, DC · Remote
$25.90 - $37.30/hr
You'll utilize clinical knowledge and critical thinking to research and review IP UM requests ... for all work. #LI-Remote Pay ranges vary based on the candidate's work location. The expected ...
Baltimore, MD · On-site +1
Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or related credentials is a plus. Working conditions This job operates in a remote location from your home ...
Baltimore, MD · On-site +1
Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or related credentials is a plus. Working conditions This job operates in a remote location from your home ...
Austin, TX; Remote This is a rare opportunity to step into a high-impact leadership role at the ... Utilization Review & Authorizations * Oversee authorization strategy and utilization review ...
Austin, TX; Remote This is a rare opportunity to step into a high-impact leadership role at the ... Utilization Review & Authorizations * Oversee authorization strategy and utilization review ...
Austin, TX; Remote This is a rare opportunity to step into a high-impact leadership role at the ... Utilization Review & Authorizations * Oversee authorization strategy and utilization review ...
Austin, TX; Remote This is a rare opportunity to step into a high-impact leadership role at the ... Utilization Review & Authorizations * Oversee authorization strategy and utilization review ...
Baltimore, MD · Remote
$20 - $24/hr
The Utilization Management Coordinator will provide administrative and operational support for ... Review authorization requests for initial determination and triage requests for clinical review and ...
Quick apply
Baltimore, MD · Remote
$20 - $24/hr
The Utilization Management Coordinator will provide administrative and operational support for ... Review authorization requests for initial determination and triage requests for clinical review and ...
Baltimore, MD · Remote
... Utilization Review, Disease Management or other direct patient care experience. Bilingual - fluent in Spanish Preferred Qualifications: * Bachelors degree in nursing * CCM/ACM or other RN Board ...
Baltimore, MD · Remote
... Utilization Review, Disease Management or other direct patient care experience. Bilingual - fluent in Spanish Preferred Qualifications: * Bachelors degree in nursing * CCM/ACM or other RN Board ...
Silver Spring, MD · Remote
$60 - $72.25/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Silver Spring, MD · Remote
$60 - $72.25/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 ...
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 ...
Ashburn, VA · Remote
$59.50 - $71.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Ashburn, VA · Remote
$59.50 - $71.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Annandale, VA · Remote
$58 - $69.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Annandale, VA · Remote
$58 - $69.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Reston, VA · On-site +1
Oversee project budgets and staffing utilization. * Review monthly financial reports and support ... Experience managing remote or distributed teams. * Excellent written and verbal communication ...
Reston, VA · On-site +1
Oversee project budgets and staffing utilization. * Review monthly financial reports and support ... Experience managing remote or distributed teams. * Excellent written and verbal communication ...
... and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG * Experience working with Commercial and Medicare/Medicaid enrollees and benefits contracts * CCM ...
... and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG * Experience working with Commercial and Medicare/Medicaid enrollees and benefits contracts * CCM ...
... 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 ...
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 - ...
Ashburn, VA · On-site +1
$58.50 - $71.25/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Ashburn, VA · On-site +1
$58.50 - $71.25/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Silver Spring, MD · On-site +1
$59 - $72/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Silver Spring, MD · On-site +1
$59 - $72/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 ...
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 ...
$22.12 - $26.59
2% of jobs
$26.59 - $31.06
9% of jobs
$34.12 is the 25th percentile. Wages below this are outliers.
$31.06 - $35.54
21% of jobs
The median wage is $39.16 / hr.
$35.54 - $40.01
23% of jobs
$40.01 - $44.48
13% of jobs
$47.96 is the 75th percentile. Wages above this are outliers.
$44.48 - $48.96
10% of jobs
$48.96 - $53.43
8% of jobs
$53.43 - $57.90
5% of jobs
$57.90 - $62.37
5% of jobs
$62.37 - $66.85
2% of jobs
$66.85 - $71.32
2% of jobs
$22
$43
$71
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.
$20 - $24/hr
Contractor
Posted 25 days ago
Job Overview:
Pay Range: $20.66/hr - $24.66/hr
Requirement/Must Have:
Responsibilities:
Nice to Have:
Skills:
Sourced by ZipRecruiter
Cynet Systems Inc is a staffing and recruiting corporation nestled in Ashburn, VA, USA. Established in 2010, the company operates within the Information Technology and Services sector, specializing in providing effective workforce solutions to different business needs, including IT consulting, direct hire, and contract staffing services. Through the years, Cynet Systems has built an impressive portfolio, going beyond borders and expanding its operations internationally in Canada and India. Rooted in its core values of teamwork, leadership, and commitment, Cynet Systems helps businesses unlock their full potential by providing versatile and competent professionals that perfectly align with their needs. Fueled by their unwavering mission to deliver top-tier talent to businesses worldwide, Cynet Systems garnered various recognitions including SIA's fastest-growing staffing firms and Best Place to Work in Virginia for 2019.
It services
501 - 1,000 Employees
Sterling, VA, US
2010
