ZipRecruiter

Log In

2

Remote Utilization Review Jobs in Springfield, OH

All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Springfield, OH

Remote Utilization Review information

See Springfield, OH salary details

$19

$38

$62

How much do remote utilization review jobs pay per hour?

As of Aug 25, 2026, the average hourly pay for remote utilization review in Springfield, OH is $38.09, according to ZipRecruiter salary data. Most workers in this role earn between $30.10 and $43.75 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 popular job titles related to Remote Utilization Review jobs in Springfield, OH?

For Remote Utilization Review jobs in Springfield, OH, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review jobs in Springfield, OH look for?

The top searched job categories for Remote Utilization Review jobs in Springfield, OH are:

What cities near Springfield, OH are hiring for Remote Utilization Review jobs?

Cities near Springfield, OH with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Springfield, OH as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $79,217 per year, or $38.1 per hour.

Medical Director (REMOTE Appeals Medical Director - Pacific Standard Time, Managed Care Experience,

CareSource

Dayton, OH • On-site, Remote

$195K - $341K/yr

Full-time

Re-posted 26 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

205th of 311 rated insurance

Job description

Job Summary:
The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members.
Essential Functions:
  • Provide prior authorization medical reviews, consultation and clinical review services
  • Participate in peer-to-peer discussions
  • Provide provider education, training, data sharing, performance evaluations and orientation to the plan
  • Conduct clinical reviews for designated CareSource members as requested
  • Provide physician review for clinical appeals cases
  • Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
  • Participate in development of policies and procedures
  • Participates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management
  • Provide cross-coverage for other Medical Directors and/or markets, as needed
  • Oversight and quality improvement activities associated with case management activities
  • Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
  • Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
  • Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
  • Collaborate with market/product leaders to help define market strategy
  • Community collaborative participation
  • Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
  • Perform any other job related instructions, as requested

Education and Experience:
  • Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
  • Successful completion of a residency training program, preferably in primary care is required
  • Minimum of five (5) years of clinical practice experience is required
  • Managed care medical review/medical director experience is preferred
  • Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred

Competencies, Knowledge and Skills:
  • Basic Microsoft Word skills
  • Excellent communication skills, both written and oral
  • Ability to work well independently and within a team environment
  • Ability to create strong relationships with Providers and Members
  • High ethical standards
  • Attention to detail
  • Critical listening and systematic thinking skills
  • Ability to maintain confidentiality and act in the company's best interest
  • Ability to act with diplomacy and sensitivity to cultural diversity
  • Decision making/problem solving skills
  • Conflict resolution skills
  • Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served

Licensure and Certification:
  • Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
  • Board Certification, preferably in primary care specialty is required
  • Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer)
  • MCG Certification is required or must be obtained within six (6) months of hire

Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • May be required to work evenings/weekends
  • May be required to travel to fulfill duties of position

Compensation Range:
$195,200.00 - $341,600.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-SW2
Brand=CareSource

What CareSource employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply