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Remote Utilization Review Jobs in Springfield, MA

Pharmacy Careers

Appeals Pharmacist (Remote)

Hartford, CT · On-site +1

$57.75 - $70.25/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Quest Global

Aftermarket Field Rep- Remote

Windsor, CT · Remote

$29 - $31/hr

Review data discrepancies and gaps across multiple systems. Escalate to appropriate channels. What ... History identifying and resolving part quality and delivery issues - including utilization of ...

Quest Global

Aftermarket Field Rep- Remote

Windsor, CT · On-site +1

$29 - $31/hr

Review data discrepancies and gaps across multiple systems. Escalate to appropriate channels. What ... History identifying and resolving part quality and delivery issues - including utilization of ...

Quest Global

Aftermarket Field Rep- Remote

Windsor, CT · Remote

$29 - $31/hr

Review data discrepancies and gaps across multiple systems. Escalate to appropriate channels. What ... History identifying and resolving part quality and delivery issues - including utilization of ...

Insurity

Manager, Professional Services

Hartford, CT · On-site +1

Drive utilization across team * Communicate financial and goal results, and KPIs to direct reports ... Demonstrated experience driving code quality through reviews, testing practices, and use of modern ...

Insurity

Manager, Professional Services

Hartford, CT · On-site +1

Drive utilization across team * Communicate financial and goal results, and KPIs to direct reports ... Demonstrated experience driving code quality through reviews, testing practices, and use of modern ...

CVS Health

AVP, Pharmacy Operations & Strategy

Hartford, CT · Remote

$130.10K - $172K/yr

Coordinate performance reviews, trend analysis, operational updates, and improvement plans across ... Remote or HybridRequirements * 12+ years of experience in health plan pharmacy, PBM, or related ...

ReSource Pro

Director Client Development

Hartford, CT · On-site +1

$120.95K - $205.03K/yr

All remote positions are based in the United States, and candidates must reside within the U.S. to ... Conduct quarterly and annual performance reviews tied to sales outcomes, including win rates, deal ...

ReSource Pro

Director Client Development

Hartford, CT · Remote

$120.95K - $205.03K/yr

All remote positions are based in the United States, and candidates must reside within the U.S. to ... Conduct quarterly and annual performance reviews tied to sales outcomes, including win rates, deal ...

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How much do remote utilization review jobs pay per hour?

As of May 29, 2026, the average hourly pay for remote utilization review in Springfield, MA is $42.13, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.37 per hour, depending on experience, location, and employer.

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 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.
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Remote Utilization Review jobs near you
Health - Network Performance / Utilization Manager

Health - Network Performance / Utilization Manager

Accenture

Hartford, CT • Remote

$94.40K - $293.80K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Accenture Federal Services rating

8.4

Company rating: 8.4 out of 10

Based on 19 frontline employees who took The Breakroom Quiz

47th of 424 rated business services

Job description

Role SummaryAdvise clients on network strategy, utilization performance, and provider market challenges across Medicaid, rural, and financially pressured environments. The successful candidate will combine deep domain expertise with strong consulting judgment and will be expected to manage teams, advise senior clients, and deliver complex engagements in network strategy, utilization, and provider performance. This individual will build trusted client relationships and help clients improve network performance, access, and provider sustainability in line with their strategic priorities.ResponsibilitiesAdvise clients on network strategy, provider capacity, utilization trends, access challenges, and market performance.Advise clients on evaluating leakage, referral patterns, service distribution, network adequacy, and provider sustainability.Develop strategic recommendations to improve network design, access, utilization management, provider alignment, and value-based outcomes.Translate claims, encounter, provider, and market data into clear insights, strategic options, and executive decision materials.Manage day-to-day engagement delivery, including workplans, team coordination, deliverable quality, and client communications.Work across reimbursement, analytics, policy, and provider strategy teams to solve complex market and performance challenges.Build trusted relationships with client stakeholders and help grow the practice's network performance and utilization work.Travel: Up to 80% as required.QualificationsMinimum of 5 years of experience in network strategy, utilization analytics, provider economics, or healthcare market analysis.Minimum of 2 years of experience assessing hospitals, rural providers, FQHCs, specialty providers, and community-based providers in Medicaid-heavy or financially distressed environments.Minimum of 2 years of experience turning claims, encounter, provider, and market data into strategic recommendations.Bachelor's Degree.Bonus points for familiarity with provider directory and network data management, data quality, and encounter completeness.Strong understanding of provider capacity, leakage, referral patterns, utilization drivers, access, and network adequacy.Ability to connect utilization performance to reimbursement, provider sustainability, and VBC outcomes.Experience building provider performance scorecards (utilization, quality, access, equity, financial impact).Understanding of service line strategy and site-of-care optimization (ASC vs HOPD, home-based care, telehealth).Compensation and BenefitsCompensation ranges by location:California: $94,400 to $293,800Cleveland: $87,400 to $235,000Colorado: $94,400 to $253,800District of Columbia: $100,500 to $270,300Illinois: $87,400 to $253,800Maryland: $94,400 to $253,800Massachusetts: $94,400 to $270,300Minnesota: $94,400 to $253,800New York: $87,400 to $293,800New Jersey: $100,500 to $293,800Washington: $100,500 to $270,300Accenture offers a market-competitive suite of benefits including medical, dental, vision, life, and long-term disability coverage, a 401(k) plan, bonus opportunities, paid holidays, and paid time off.Equal Employment Opportunity StatementWe believe that no one should be discriminated against because of their differences.

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.Accenture is an EEO and affirmative action employer of veterans/individuals with disabilities.Accenture is committed to providing veteran employment opportunities to our service men and women.J-18808-Ljbffr

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