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Virtual Utilization Review Specialist Jobs (NOW HIRING)

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private ...

RECAP INC

Utilization Review Specialist

Middletown, NY · On-site

$27 - $34/hr

As a Utilization Review Specialist, you will play a vital role in ensuring that clinical services are medically necessary, appropriately authorized, and compliant with all regulatory and payer ...

Emory Healthcare

Utilization Review Specialist

Atlanta, GA · Remote

$47.40 - $54.95/hr

The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough medical necessity reviews to assist with determining appropriate patient class designation. The UR ...

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Virtual Utilization Review Specialist information

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

As of Sep 15, 2026, the average hourly pay for virtual utilization review specialist 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 is a virtual utilization review specialist?

Virtual Utilization Review Specialists are healthcare professionals who assess the necessity, efficiency, and appropriateness of medical services provided to patients, typically working remotely. They review patient records and treatment plans to ensure they meet established guidelines and payer requirements. Their work helps optimize patient care, control healthcare costs, and ensure compliance with insurance policies. These specialists often collaborate with physicians, nurses, and insurance companies using digital tools and secure platforms.

How does a virtual utilization review specialist typically collaborate with healthcare providers and insurance companies while working remotely?

As a Virtual Utilization Review Specialist, you'll regularly interact with healthcare providers and insurance representatives through secure digital platforms, email, and phone calls. Your role involves reviewing patient records, clarifying treatment plans, and ensuring documentation meets payer requirements for medical necessity. Effective communication and strong organizational skills are essential, as you'll need to coordinate with multiple parties, handle confidential information, and resolve discrepancies promptly. Most specialists work independently within a broader clinical or case management team, participating in virtual meetings to discuss complex cases and stay updated on regulatory changes.

What are the key skills and qualifications needed to thrive as a virtual utilization review specialist, and why are they important?

To excel as a Virtual Utilization Review Specialist, you need a background in nursing or healthcare, strong knowledge of clinical guidelines, and relevant licensure (such as RN or LPN). Familiarity with electronic medical record (EMR) systems, utilization management software, and UM certification (like CCM or URAC) is typically required. Outstanding analytical thinking, attention to detail, and effective communication skills are crucial for collaborating with healthcare providers and advocating for appropriate care. These competencies are vital to ensuring accurate case reviews, optimal patient outcomes, and adherence to regulatory and payer requirements in a remote setting.

What is the difference between Virtual Utilization Review Specialist vs Virtual Case Manager?

AspectVirtual Utilization Review SpecialistVirtual Case Manager
CredentialsTypically requires healthcare-related certifications (e.g., RN, CPC)Often requires social work, nursing, or healthcare certifications
Work EnvironmentRemote, focused on reviewing medical necessity and insurance claimsRemote, involved in coordinating patient care and discharge planning
Employer & IndustryInsurance companies, healthcare providers, third-party administratorsHospitals, insurance companies, healthcare agencies

The Virtual Utilization Review Specialist primarily evaluates medical necessity for insurance claims, focusing on reviewing patient records remotely. In contrast, the Virtual Case Manager manages patient care plans and coordinates services virtually. Both roles require healthcare certifications and operate in similar remote environments, but their core responsibilities differ in focus and daily tasks.

What cities are hiring for Virtual Utilization Review Specialist jobs?

Cities with the most Virtual Utilization Review Specialist job openings:

What are the most commonly searched types of Utilization Review Specialist jobs?

The most popular types of Utilization Review Specialist jobs are:

What states have the most Virtual Utilization Review Specialist jobs?

States with the most job openings for Virtual Utilization Review Specialist jobs include:

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For Virtual Utilization Review Specialist jobs, the most frequently searched job titles are:

Infographic showing various Virtual Utilization Review Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

Utilization Review Specialist

Tulsa, OK

Parkside Hospital
See more jobs at Parkside Hospitalexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago

Job description

Parkside provides professional purpose, hope, and healing. As a member of our staff, you will be part of a mission-driven team, dedicated to changing lives and changing communities, one patient at a time. 

Parkside Psychiatric Hospital & Outpatient Clinic is a comprehensive mental healthcare system providing acute inpatient care, residential treatment, and outpatient therapy. With a focus on society’s most vulnerable population, Parkside provides world-class mental health services for youth and adults. For over 65 years, Parkside’s physicians, therapists, and staff have provided state of the art, patient-centered care that propels families from hopeful to hope-filled. As a center of excellence, we cultivate talent and provide professional purpose. Together we facilitate healing, one patient at a time. 

We are looking for a Full Time Utilization Review Specialist! The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private insurance. Coordinates with clinicians, business office and medical records to achieve above goals.

Responsibilities:

• Prepares authorization paperwork, processes requests for authorizations, and reviews requests for accuracy.

• Communicates with clinicians regarding discharge issues relevant to patient’s pay source. Tracks due dates for authorization reviews and alerts clinicians.

• Communicates with clinicians regarding admissions and discharges to various units.

• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage. Maintains current knowledge of managed care requirements and accurately interprets these requirements to increase authorizations.

• Coordinates/completes the appeal process for authorization denials

• Performs audits of clinical services to ensure compliance with standards of third party pay sources and agency policies.

• Tracks unauthorized services and possible recoupment issues. Looks for possible corrections, trends.

 • Maintains a good working relationship within the department and with other departments.

• Documentation meets current standards and policies.

 • Maintains fit for duty. Acts in a professional manner and follows all Parkside policies and procedures.

• Orients new staff members to the unit

• Demonstrates the ability to be organized and flexible, acts appropriately in stressful/emergency situations. Able to provide Handle with Care when needed

• Performs other duties as assigned

  • Bachelor’s degree in related field from an accredited university required. Experience in lieu of Degree will be considered.
  • 2yrs minimal experience in health care, utilization review and business setting

Benefits include:

  • Medical, Dental, and Vision
  • Generous Paid Time Off and Holidays
  • 401K and match start immediately, and includes a generous match
  • Company Paid Life Insurance and Disability and more!

We are an Equal Opportunity Employer! 

Apply