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Work From Home Utilization Review Jobs (NOW HIRING)

UK St Claire

Utilization Review Nurse

Morehead, KY · On-site +1

Essential Functions • Abstracts and assembles data from printed and online sources. • Reviews ... Volunteer work and internships for academic credit are not counted. Certifications & Licensures ...

CorVel

CA Utilization Review Nurse I

$30.64 - $45.80/hr

Documents all work in the appropriate manner * Promotes utilization review services with stakeholders * Complies with all safety rules and regulations during work hours in conjunction with the Injury ...

Med Review Inc

Physician Reviewer

This is a fully remote opportunity for a physician with a strong background in utilization review ... - work from anywhere in the U.S * High-impact role influencing clinical accuracy and healthcare ...

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Work From Home Utilization Review information

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$31

$53

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

As of Jul 14, 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.
ABA Utilization Review (UR) Specialist

ABA Utilization Review (UR) Specialist

Spectrum Billing Solutions

Skokie, IL • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 15 days ago

Job description

Spectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers. Our team has deep industry knowledge, technology, and experience to ensure our client's revenue cycle is managed in the most efficient and streamlined manner.
We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for ABA and related services. The ideal candidate is passionate, motivated, detail-oriented and interested in working in a cohesive and rewarding environment.
This is a fully remote or office/home hybrid position.
Your Responsibilities:
  • Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines.
  • Obtain initial and continuing authorization for treatment services.
  • Manage authorization denials including referral for peer review.
  • Document and record all necessary information.
  • Monitor and track new and ongoing authorization cases.
  • Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed.
  • Assist external clients in understanding payer requirements for authorizations.
  • Participate in team meetings.
  • Maintain confidentiality of patient information and adhere to HIPAA regulations.
What we offer you:
  • Flexible work environment
  • Competitive Salary
  • A close-knit team of talented and skilled individuals.
  • Growth opportunities
  • Benefits - Medical, Dental, Vision
  • Flexible Paid Time Off
  • 401K with Company match
  • Supplemental Benefits
Qualifications:
  • 3-5 years of related ABA and/or Behavioral Health experience.
  • Bachelor's or master's degree preferred.
  • Superior written and oral communication skills
  • Attention to detail to ensure necessary information is captured and properly documented.
  • Ability to work independently and within a team.
  • Ability to multi-task, prioritize and meet expected deadlines.
  • Solid understanding of insurance benefits and coverages.
  • Strong computer skills (Word, Excel, billing software).
  • Understanding of mental and behavioral health treatment services.
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