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Work From Home Utilization Review Social Worker Jobs in Boca Raton, FL

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Work From Home Utilization Review Social Worker information

See Boca Raton, FL salary details

$20

$40

$65

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

As of Sep 5, 2026, the average hourly pay for work from home utilization review social worker in Boca Raton, FL is $40.12, according to ZipRecruiter salary data. Most workers in this role earn between $31.73 and $46.06 per hour, depending on experience, location, and employer.

What is a work from home utilization review social worker?

A Work From Home Utilization Review Social Worker is a licensed social worker who evaluates the necessity, appropriateness, and efficiency of healthcare services from a remote location. They review patient records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their work helps manage healthcare costs and promotes quality patient care, all while allowing them to perform their duties from home.

What are the key skills and qualifications needed to thrive as a work from home utilization review social worker?

To thrive as a Work From Home Utilization Review Social Worker, you need a background in social work (often with an MSW and state licensure), strong clinical assessment skills, and familiarity with healthcare regulations. Experience with utilization management software, electronic health records (EHRs), and knowledge of insurance authorization processes are typically required. Excellent communication, organization, and critical thinking skills set outstanding professionals apart in this remote environment. These competencies ensure accurate case reviews, compliance with policies, and effective advocacy for patient care while working independently.

What are some common challenges faced by work from home utilization review social workers, and how can they be managed?

Work From Home Utilization Review Social Workers often encounter challenges such as managing high caseloads, ensuring clear communication with healthcare teams remotely, and staying updated on constantly changing insurance and healthcare regulations. To address these, it's important to develop strong organizational skills, utilize collaborative technology platforms, and participate in ongoing training sessions. Regular virtual meetings and proactive communication with colleagues and providers also help maintain effective teamwork and high-quality patient care.

What is the difference between Work From Home Utilization Review Social Worker vs Utilization Review Nurse?

AspectWork From Home Utilization Review Social WorkerUtilization Review Nurse
CredentialsSocial Work degree, LCSW or similar licenseRegistered Nurse (RN) license, BSN or higher
Work EnvironmentRemote, primarily administrative reviewRemote or onsite, clinical assessment involved
Industry UsageHealthcare, insurance, managed careHealthcare, insurance, managed care
Job FocusAssessing social and mental health needs for coverageReviewing medical necessity based on clinical data

Both roles involve remote work within healthcare and insurance sectors, but the Social Worker focuses on social and mental health assessments, while the Nurse emphasizes clinical medical reviews. Understanding these differences helps job seekers find the right fit based on credentials and job responsibilities.

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What cities near Boca Raton, FL are hiring for Work From Home Utilization Review Social Worker jobs?

Cities near Boca Raton, FL with the most Work From Home Utilization Review Social Worker job openings:

Work From Home Utilization Review Social Worker jobs near you

Utilization Review Coordinator

NRG MGMT LLC

Lake Worth, FL • Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 14 days ago

Job description

Remedial Pro is a specialized medical billing company serving substance abuse treatment and behavioral health providers. Through services including benefits verification, billing and claims submission, and utilization review, we help treatment centers optimize revenue cycle management while focusing on delivering exceptional patient care. Our team is committed to accuracy, professionalism, efficiency, and outstanding client service

JOB DESCRIPTION

The primary goal is to monitor adherence to the facility’s utilization review plan to ensure the effective and efficient use of facility services and monitor the appropriateness of facility  admissions and extended facility stays.

Job Classification: Non Exempt Hourly        Reports To: Senior RCM Director

Supervisory Responsibilities:   None.

JOB DUTIES:

  • Completes Initial, concurrent, peer reviews, and expedited appeals in a timely manner to ensure continuous coverage.
  • responsible for all aspects of the authorization of treatment via insurance and managed care companies.
  • Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
  • Collaborate with facilities in order to obtain necessary clinical documentation for reviews and ensure appropriate lengths of stay and effective utilization of resources.
  • Represents the company in a positive manner per the Professional Standards of Conduct
  • Protects the confidentiality of patients and the privacy of staff
  • provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.
  • Uses a computer to type correspondence, reports and other items as requested,
  • Experience in the Mental Health/Addiction space, May be a fully licensed SUDC, CAC,LADC, LCSW, CMHC or RN
  • Additional duties as assigned.

MINIMUM QUALIFICATIONS

  • Bachelor’s or Master’s degree in Behavioral/Mental Health Field (or related experience) preferred
  • A minimum of 3-5 years experience doing utilization review is required preferred
  • Expertise in psychiatric and addiction disorders
  • Experience interacting effectively with co-workers as well as clients.
  • Experience maintaining confidentiality in accordance with HIPAA and company policy requirements.

Required Skills/Abilities:

  • Excellent verbal and written communication skills.
  • Excellent organizational skills and attention to detail.
  • Excellent time management skills with a proven ability to meet deadlines.
  • Proficient with Microsoft Office Suite or related software.
PHYSICAL REQUIREMENTS
  • Prolonged periods sitting at a desk and working on a computer.

Remote Position

Benefits:

• Competitive salary

• Health, dental, and vision insurance

• 401(k) with company match

• Paid time off and holidays

• Continuing education and professional development opportunities

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