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Work From Home Utilization Review Jobs (NOW HIRING)

Franciscan Health

Utilization Review Coordinator

Work From Home Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for ...

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 ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... While your daily work will be completed from your home office, occasional travel may be required ...

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How much do work from home utilization review jobs pay per hour?

As of Jul 13, 2026, the average hourly pay for work from home utilization review 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 some common challenges faced by Work From Home Utilization Review professionals, and how can they be managed?

Work From Home Utilization Review professionals often face challenges such as maintaining effective communication with healthcare providers and team members, managing time efficiently without in-person supervision, and navigating multiple electronic health record systems remotely. To manage these challenges, it’s important to establish clear communication channels, set structured daily routines, and stay updated with technology training. Many organizations offer virtual team meetings and resources to support remote collaboration and continuous professional development.

What are the key skills and qualifications needed to thrive as a Work From Home Utilization Review Nurse, and why are they important?

To thrive as a Work From Home Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) are often required. Exceptional communication, critical thinking, and time management skills help in effectively coordinating care and interacting with patients and providers remotely. These skills ensure accurate and efficient reviews, compliance with guidelines, and optimal patient outcomes while working independently.

What is a Work From Home Utilization Review job?

A Work From Home Utilization Review job involves evaluating the necessity, appropriateness, and efficiency of medical services provided to patients, typically for insurance companies or healthcare organizations. Employees in this role review patient records, treatment plans, and medical claims to ensure compliance with established guidelines and standards. Working remotely, these professionals often communicate with healthcare providers, patients, and insurance representatives to gather information and make recommendations regarding coverage or continued care.

What is the difference between Work From Home Utilization Review vs Work From Home Medical Coder?

AspectWork From Home Utilization ReviewWork From Home Medical Coder
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical reviewer credentialsRequires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentRemote, often involves reviewing medical records and insurance claimsRemote, involves reviewing and assigning medical codes to patient records
Industry UsageCommon in insurance, healthcare administration, and utilization managementCommon in medical billing, coding, and healthcare documentation

Work From Home Utilization Review and Work From Home Medical Coder roles both operate remotely within the healthcare industry. While utilization reviewers focus on assessing the necessity of medical services, medical coders assign standardized codes to patient records. Both require healthcare-related certifications and are essential for healthcare administration, but they differ in daily tasks and specific credentials.

More about Work From Home Utilization Review jobs
What cities are hiring for Work From Home Utilization Review jobs? Cities with the most Work From Home Utilization Review job openings:
What states have the most Work From Home Utilization Review jobs? States with the most job openings for Work From Home Utilization Review jobs include:
What job categories do people searching Work From Home Utilization Review jobs look for? The top searched job categories for Work From Home Utilization Review jobs are:
Work From Home Utilization Review jobs near you
Infographic showing various Work From Home Utilization Review job openings in the United States as of July 2026, with employment types broken down into 80% Full Time, and 20% Contract. Highlights an 100% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.
Utilization Review Coordinator

Utilization Review Coordinator

Franciscan Health

Remote

Full-time

Posted 18 days ago

Franciscan Health rating

6.8

Company rating: 6.8 out of 10

Based on 266 frontline employees who took The Breakroom Quiz

491st of 882 rated healthcare providers

Job description

Work From Home
Work From Home Work From Home, Indiana 46544
The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization.
WHO WE ARE
With 11 ministries and access points across Indiana, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.
WHAT YOU CAN EXPECT
  • Schedule: Monday - Friday, 8am - 4:30pm EST
  • Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes.
  • Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office staff, Denial Management staff, and third-party payors to justify the admission or continued stay.
  • Notify appropriate staff members of any admission, service, length of stay, lack of medical necessity criteria, as well as denials/appeals and issuing of letters to patients.
  • Provide Physician, Patient, Family, Staff and Student education.
  • Act as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues.
  • Perform admission necessity screening using criteria as established by the various federal, state and private sector programs.

QUALIFICATIONS
  • Associate degree in nursing/patient care required
  • Bachelor's Degree in nursing/patient care preferred
  • Registered Nurse (RN - Indiana licensure) required
  • 3 years of nursing/patient care experience required
  • 2 years of Utilization or Case Management experience preferred

TRAVEL IS REQUIRED:
Never or Rarely
JOB RANGE:
Utilization Review Coordinator $56971.20-$84749.60
INCENTIVE:
Not Applicable
EQUAL OPPORTUNITY EMPLOYER
It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.
Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.
Franciscan Alliance is committed to equal employment opportunity.
Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

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