ZipRecruiter

Log In

2

Supervisor Utilization Review Remote Jobs in Florida

MRIoA

Child & Adolescent Psychiatrist

Orlando, FL · On-site +1

We are currently seeking Board-Certified physicians in Child & Adolescent Psychiatry to conduct independent Utilization Reviews . This is a flexible, fully remote opportunity requiring just 1-2 hours ...

NRG MGMT LLC

Collections Specialist

Lake Worth, FL · On-site +1

$16.50 - $22.25/hr

... utilization review, and insurance verification for substance abuse and mental health treatment ... Work Environment Office or remote work environment, depending on company policy. Fast-paced ...

ARC Group

Medical Director

Jacksonville, FL · Remote

MEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for a Medical Director! This ... Work experience in the health insurance industry, a utilization review firm, or another health care ...

Liberty Dental Plan Careers

Senior Staff Dentist

Tampa, FL · Remote

$175K - $185K/yr

Conduct retrospective utilization reviews and support provider behavior change initiatives ... Remote role with collaboration across national teams * High-impact role shaping clinical standards ...

LIBERTY DENTAL

Senior Staff Dentist

Tampa, FL · On-site +1

$175K - $185K/yr

Conduct retrospective utilization reviews and support provider behavior change initiatives ... Remote role with collaboration across national teams * High-impact role shaping clinical standards ...

previous page

Showing results 41-60

All JobsSupervisor Utilization Review JobsSupervisor Utilization Review Remote JobsSupervisor Utilization Review Remote Jobs in Florida

Supervisor Utilization Review Remote information

What does a supervisor utilization review remote do?

A Supervisor Utilization Review (Remote) oversees a team responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients—often for insurance or healthcare organizations. This role ensures that utilization review processes comply with regulatory requirements and organizational standards, while also guiding and supporting staff in their daily activities. Working remotely, the supervisor collaborates with clinicians, case managers, and other stakeholders to facilitate quality patient care and manage healthcare costs. The supervisor may also handle escalated cases and ensure timely completion of reviews.

What are the key skills and qualifications needed to thrive as a supervisor utilization review remote?

To thrive as a Supervisor Utilization Review Remote, you need a solid background in clinical healthcare (often as an RN or similar), experience with utilization management, and knowledge of regulatory guidelines. Familiarity with utilization review software, electronic medical records (EMR), and certifications like CCM or URAC accreditation are typically required. Strong leadership, critical thinking, and effective communication skills help in managing teams and collaborating across departments. These skills ensure efficient review processes, compliance with regulations, and high-quality patient care management in a remote setting.

What are some common challenges faced by remote supervisor utilization review professionals, and how can they be effectively managed?

Remote Supervisor Utilization Review professionals often encounter challenges such as coordinating with distributed team members, ensuring consistent application of review criteria, and maintaining clear communication with both clinical staff and payers. To manage these, it's important to establish regular virtual meetings, utilize secure and efficient digital platforms for case tracking, and foster a culture of transparency and accountability. Additionally, investing time in ongoing training and encouraging peer collaboration can help supervisors stay updated on regulatory changes and best practices.

What is the difference between Supervisor Utilization Review Remote vs Utilization Review Nurse?

AspectSupervisor Utilization Review RemoteUtilization Review Nurse
CredentialsRN license, possibly supervisor certificationRN license, certification in utilization review often preferred
Work EnvironmentRemote, supervisory role overseeing review teamsRemote or onsite, performing case assessments
Employer & IndustryHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers

The Supervisor Utilization Review Remote typically oversees review teams and manages processes, requiring leadership skills and certifications. In contrast, Utilization Review Nurses focus on case assessments and approvals, often with similar certifications but less managerial responsibility. Both roles are essential in healthcare utilization management, often working remotely within the same industry.

What are popular job titles related to Supervisor Utilization Review Remote jobs in Florida?

For Supervisor Utilization Review Remote jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Supervisor Utilization Review Remote jobs in Florida look for?

The top searched job categories for Supervisor Utilization Review Remote jobs in Florida are:

What cities in Florida are hiring for Supervisor Utilization Review Remote jobs?

Cities in Florida with the most Supervisor Utilization Review Remote job openings:

Supervisor Utilization Review Remote jobs near you

Medical Director Utilization Management Oncology

The Oncology Institute of Hope and Innovation

Miami, FL • Remote

$275K - $325K/yr

Full-time

Re-posted 4 days ago

Job description

Starling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With more than 400 employed and network clinicians and over 100 clinics and network locations of care across five states and growing, Starling Oncology is changing oncology for the better. For more information, visit www.starlingoncology.com.

Utilization Management Medical Director Oncology

Work Location: REMOTE (work from home)

California Nevada Arizona Oregon Florida

The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with a focus on direct utilization management for case review and clinical decision making.

In this collaborative role, you will work with physicians, clinical teams and operational leaders to support evidence-based high quality and cost-effective care delivery across the network. You will also contribute to cross-functional initiatives, data-driven insights, and oversight of utilization management policies to optimize patient outcomes.

 Key Responsibilities:

  • Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices.
  • Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.
  • Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness.
  • Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage.
  • Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement
  • Partner with clinical and operational teams to support value-based care.
  • Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions.
  • Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology.

Qualifications:

  • Medical degree (MD or DO)
  • Board Certification in Oncology.
  • Minimum of 5 years of clinical experience in oncology.
  • 2+ years of Utilization Management experience
  • Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans.
  • Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies.
  • Excellent analytical skills and the ability to evaluate complex clinical data.
  • Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting.
  • Excellent communication skills to engage effectively with healthcare providers, payers, and patients.

If you're interested in learning more, but not ready to apply, please reach out to our team to set-up a call at your convenience. Physiciancareers@theoncologyinstitute.com

Ready to apply? Please complete the simple application and our team will reach out to you quickly.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role.

Pay Transparency for salaried teammates
$275,000—$325,000 USD