5 Remote Utilization Review Jobs You Can Apply

The healthcare industry has undergone significant changes in recent years, with a growing emphasis on remote work and digital solutions. One area that has seen a notable shift is utilization review, which involves evaluating the necessity and efficiency of medical treatments and services. As a result, remote utilization review jobs have become increasingly popular, offering professionals the opportunity to work from the comfort of their own homes while still making a meaningful contribution to the healthcare system.

In this article, we will explore five remote utilization review jobs that you can apply for, along with their responsibilities, requirements, and benefits.

Understanding Remote Utilization Review Jobs

Before we dive into the specific job listings, it's essential to understand what remote utilization review jobs entail. These roles typically involve reviewing medical records, assessing the necessity of treatments and services, and making informed decisions about coverage and reimbursement. Utilization review professionals work closely with healthcare providers, patients, and insurance companies to ensure that medical services are delivered efficiently and effectively.

Job 1: Remote Utilization Review Nurse

• Company: UnitedHealth Group
• Job Type: Full-time
• Location: Remote
• Requirements: Registered Nurse (RN) license, 2+ years of utilization review experience
• Job Description: Conduct reviews of medical records to determine the necessity of treatments and services. Collaborate with healthcare providers and insurance companies to ensure efficient delivery of medical services.

Responsibilities:

• Review medical records to assess the necessity of treatments and services
• Collaborate with healthcare providers and insurance companies to ensure efficient delivery of medical services
• Make informed decisions about coverage and reimbursement
• Develop and implement utilization review guidelines and policies

Job 2: Utilization Review Specialist

• Company: Anthem, Inc.
• Job Type: Full-time
• Location: Remote
• Requirements: Bachelor's degree in a healthcare-related field, 2+ years of utilization review experience
• Job Description: Conduct reviews of medical records to determine the necessity of treatments and services. Analyze data to identify trends and opportunities for improvement.

Responsibilities:

• Review medical records to assess the necessity of treatments and services
• Analyze data to identify trends and opportunities for improvement
• Develop and implement utilization review guidelines and policies
• Collaborate with healthcare providers and insurance companies to ensure efficient delivery of medical services

Job 3: Remote Clinical Reviewer

• Company: Humana
• Job Type: Full-time
• Location: Remote
• Requirements: Clinical degree (e.g., MD, DO, PA, NP), 2+ years of clinical review experience
• Job Description: Conduct reviews of medical records to determine the necessity of treatments and services. Collaborate with healthcare providers and insurance companies to ensure efficient delivery of medical services.

Responsibilities:

• Review medical records to assess the necessity of treatments and services
• Collaborate with healthcare providers and insurance companies to ensure efficient delivery of medical services
• Make informed decisions about coverage and reimbursement
• Develop and implement clinical review guidelines and policies

Job 4: Utilization Management Nurse

• Company: Aetna
• Job Type: Full-time
• Location: Remote
• Requirements: Registered Nurse (RN) license, 2+ years of utilization management experience
• Job Description: Conduct reviews of medical records to determine the necessity of treatments and services. Collaborate with healthcare providers and insurance companies to ensure efficient delivery of medical services.

Responsibilities:

• Review medical records to assess the necessity of treatments and services
• Collaborate with healthcare providers and insurance companies to ensure efficient delivery of medical services
• Make informed decisions about coverage and reimbursement
• Develop and implement utilization management guidelines and policies

Job 5: Clinical Utilization Reviewer

• Company: Cigna
• Job Type: Full-time
• Location: Remote
• Requirements: Clinical degree (e.g., MD, DO, PA, NP), 2+ years of clinical review experience
• Job Description: Conduct reviews of medical records to determine the necessity of treatments and services. Analyze data to identify trends and opportunities for improvement.

Responsibilities:

• Review medical records to assess the necessity of treatments and services
• Analyze data to identify trends and opportunities for improvement
• Collaborate with healthcare providers and insurance companies to ensure efficient delivery of medical services
• Develop and implement clinical review guidelines and policies

Conclusion

Remote utilization review jobs offer a unique opportunity for healthcare professionals to work from home while still making a meaningful contribution to the healthcare system. With the increasing demand for remote work, it's essential to explore these job listings and consider a career in utilization review.

By applying for these remote utilization review jobs, you can gain experience in a rapidly growing field, work with a variety of healthcare providers and insurance companies, and develop a range of skills that are highly valued in the industry.