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Utilization Review Specialist Remote Jobs (NOW HIRING)

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

R1

Utilization Review Author-Remote

$65K - $96K/yr

The Utilization Review Specialist will be part of our Physician Advisory Team providing first level initial admission and continued stay case reviews. The Utilization Review Specialist will determine ...

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

... Review Specialists and oversee Utilization Review operations. This role coordinates with Clinical ... This position is posted as remote; however, per company policy, candidates residing within a ...

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

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How much do utilization review specialist remote jobs pay per hour?

As of Jun 14, 2026, the average hourly pay for utilization review specialist remote in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What are Utilization Review Specialists (Remote)?

Utilization Review Specialists (Remote) are healthcare professionals who work from home to evaluate the necessity, appropriateness, and efficiency of medical treatments and services. They review patient records, medical documentation, and insurance information to ensure healthcare services meet established guidelines and regulations. Their goal is to help manage healthcare costs while ensuring patients receive appropriate care, often acting as a liaison between healthcare providers, insurance companies, and patients.

What are the key skills and qualifications needed to thrive as a Utilization Review Specialist (Remote), and why are they important?

To thrive as a Utilization Review Specialist (Remote), you need expertise in clinical guidelines, medical terminology, and case management, often backed by a nursing or healthcare-related degree and relevant licensure. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance policies or regulatory compliance is typically required. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for this role. These skills ensure accurate case evaluations, regulatory adherence, and effective collaboration with healthcare providers and payers.

How does a remote Utilization Review Specialist typically collaborate with healthcare providers and insurance companies?

As a remote Utilization Review Specialist, you’ll frequently interact with healthcare providers and insurance representatives via phone, email, and secure digital platforms. Collaboration often involves reviewing patient records, clarifying clinical details, and ensuring documentation meets payer requirements. Maintaining clear, timely communication is crucial for resolving discrepancies and facilitating care authorizations. Most organizations utilize electronic health record (EHR) systems and case management software to streamline these interactions and support remote teamwork.
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Utilization Review Specialist Remote jobs near you

Utilization Review Specialist

Cutting Edge Staffing LLC

Pompano Beach, FL • Remote

Full-time

Posted 8 days ago

Job description

Exciting Opportunity with Banyan Treatment Centers!

We are seeking a Utilization Review Specialist to join our corporate team in Pompano Beach, FL. The position is responsible for contacting external case managers and managed care organizations for pre-authorization and concurrent reviews for the duration of a patient’s treatment stay. They also establish and maintain contracts with managed care companies and requests rate increases when deemed appropriate.

Position Details:
  • Reports To: Director of Utilization Review
  • Schedule: Full-Time, Weekdays (Weekend availability as needed).
  • Location: Remote
Key Responsibilities:

  • Manage a caseload of 50–75 patients and authorize 15–25 cases daily, ensuring timely utilization reviews and appropriate level of care.

  • Verify insurance benefits, coordinate authorizations, and communicate effectively with managed care providers.

  • Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards.

  • Collaborate with clinical and billing departments to support discharge planning, documentation, and timely reimbursement.

  • Identify and address over/underutilization trends and assist in resolving outstanding case issues with insurers.

Requirements:
  • High School diploma or equivalent; graduate degree in a health or behavioral health related field preferred.
  • Minimum of one-year experience working in a utilization review position (psychiatric or chemical dependency).
    Why Join Banyan Treatment Centers?

    This is more than a job, it’s a chance to be a vital part of what recovery looks like after treatment. As a Utilization Review Specialist, you’ll help ensure that each client leaves treatment with a clear plan, strong connections, and the resources they need to continue their recovery journey with confidence.

    • Join a Mission-Driven, Nationally Recognized Organization: We’re accredited by the Joint Commission and backed by TPG’s Rise Fund, with 18 locations and Telehealth services nationwide.
    • Champion the Continuum of Care: Be a key player in ensuring clients transition successfully from treatment into long-term recovery supports.
    • Work in Partnership: Collaborate with clinical, operational, and business development teams, as well as families and external partners, to make sure no detail is missed.
    • Enjoy Comprehensive Benefits: Including medical, vision, and dental insurance; whole and term life insurance; short- and long-term disability coverage; 401(k) with employer match; paid time off and holidays; and wellness, assistance, and referral programs.
    Apply Now!

    If you're passionate about building bridges to lasting recovery and ensuring every patient has a plan beyond our doors, apply today and help us continue making a difference at Banyan Treatment Centers.

    We are an Equal Opportunity Employer and welcome applicants of all backgrounds. We encourage veterans, active-duty military, and first responders to apply in support of our First Responders Program.